Provider Demographics
NPI:1881734572
Name:NAVARRO, NICANOR JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:NICANOR
Middle Name:JUAN
Last Name:NAVARRO
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 1:995 PRICE RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5453
Mailing Address - Country:US
Mailing Address - Phone:630-876-9055
Mailing Address - Fax:630-876-8307
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2835
Practice Address - Country:US
Practice Address - Phone:630-876-9055
Practice Address - Fax:630-876-8307
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062881Medicaid
IL036062881Medicaid
ILE79855Medicare UPIN