Provider Demographics
NPI:1669866836
Name:REISH, NICHOLAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:REISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:259 E ERIE ST FL 19
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-695-7950
Mailing Address - Fax:312-695-5747
Practice Address - Street 1:15300 WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4686
Practice Address - Country:US
Practice Address - Phone:708-226-2870
Practice Address - Fax:708-226-2315
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2022-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1491882084N0400X, 2084V0102X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology