Provider Demographics
NPI:1811458466
Name:PAPROCKI, NICOLE MARIE
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:PAPROCKI
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 1:6250 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2530
Mailing Address - Country:US
Mailing Address - Phone:312-682-6110
Mailing Address - Fax:
Practice Address - Street 1:6250 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2530
Practice Address - Country:US
Practice Address - Phone:312-682-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125073777207Q00000X
IL125.073777207Q00000X
390200000X
IL036.160075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program