Provider Demographics
NPI:1598968976
Name:PFANZELTER, NICKLAS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:NICKLAS
Middle Name:ROBERT
Last Name:PFANZELTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 PFINGSTEN RD.
Mailing Address - Street 2:KELLOGG CANCER CENTER
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1339
Mailing Address - Country:US
Mailing Address - Phone:847-503-1000
Mailing Address - Fax:847-503-1100
Practice Address - Street 1:2180 PFINGSTEN RD.
Practice Address - Street 2:KELLOGG CANCER CENTER
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-503-1000
Practice Address - Fax:847-503-1100
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133170207RX0202X
IL036.133170207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology