Provider Demographics
NPI:1447233705
Name:JAMES PATRICK, NANETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:MARIE
Last Name:JAMES PATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:773-233-0873
Mailing Address - Fax:
Practice Address - Street 1:3700 W 203RD ST
Practice Address - Street 2:SUITE110
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1180
Practice Address - Country:US
Practice Address - Phone:708-679-1890
Practice Address - Fax:708-747-9859
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085974Medicaid
IL594850Medicare ID - Type UnspecifiedGROUP
IL036085974Medicaid