Provider Demographics
NPI:1417122763
Name:NICOLA, HEIDI AZMY (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:AZMY
Last Name:NICOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAIDY
Other - Middle Name:AZMY
Other - Last Name:MOAWAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:100 W 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2003
Practice Address - Country:US
Practice Address - Phone:312-609-0300
Practice Address - Fax:312-842-5897
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine