Brian Nickoloff, MD PHD

Primary specialty

Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X

License

36092377 Issued in IL

Practice address

2160 S First Ave
(EMS BLDG., RM. 2209)
Maywood, IL 60153

Phone

(708) 216-3250

Fax

(708) 216-2620

NPI assigned

Jan 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267660800000",
    "number": "1104806272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVE",
            "address_2": "(EMS BLDG., RM. 2209)",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-3250",
            "fax_number": "708-216-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVE",
            "address_2": "(EMS BLDG., RM. 2209)",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-3250",
            "fax_number": "708-216-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKOLOFF",
        "first_name": "BRIAN",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2010-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "IL",
            "license": "36092377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36092377",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nghiem Hoa Nguyen
• Stephanie Thuy Trang Nguyen
• Theresa Nguyen, MD
• Vivian Nguyen, DO
• Nicholas R Tokarski DDS PC
• Magan Rae Nielsen, ANP-BC
• Kathryn Elizabeth Niemeyer, M.D.
• Claire Niewiara, MD
• Mira Nigudkar, BS
• Petar Nikolic, MD

• Dermatopathology (Pathology) Physician in Maywood, IL
• Providers in Maywood, IL by specialty
• Dermatopathology (Pathology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.