Provider Demographics
NPI:1396994141
Name:BEAUBIER, NIKE (MD)
Entity type:Individual
Prefix:
First Name:NIKE
Middle Name:
Last Name:BEAUBIER
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 1:333 E ONTARIO ST
Mailing Address - Street 2:APT# 3109B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4804
Mailing Address - Country:US
Mailing Address - Phone:917-822-6325
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:FEINBERG 7-220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130750207ZP0101X, 207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology