Provider Demographics
NPI:1659860823
Name:ALIBIN, NICCALE TENIKA
Entity Type:Individual
Prefix:
First Name:NICCALE
Middle Name:TENIKA
Last Name:ALIBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N CLINTON ST FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1419
Mailing Address - Country:US
Mailing Address - Phone:847-502-4898
Mailing Address - Fax:
Practice Address - Street 1:180 COUNTY ROAD 300
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-5216
Practice Address - Country:US
Practice Address - Phone:847-790-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3083213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
390200000XOtherSTUDENT HEALTH CARE