Provider Demographics
NPI:1750898367
Name:NSO, NSO AGBOR (MD)
Entity type:Individual
Prefix:
First Name:NSO
Middle Name:AGBOR
Last Name:NSO
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 1:2650 RIDGE AVE.
Mailing Address - Street 2:IM/ICU HOSPITALISTS
Mailing Address - City:BURR EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1010
Mailing Address - Fax:847-733-5108
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:IM/ICU HOSPITALISTS
Practice Address - City:BURR EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-1010
Practice Address - Fax:847-733-5108
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 251G00000X, 251J00000X, 251E00000X, 251S00000X
IL036167294207RC0000X, 207R00000X, 208M00000X
IL125079225207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No251E00000XAgenciesHome Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No251S00000XAgenciesCommunity/Behavioral Health