Active NPI
Nickola Novosel, MD
- Gynecology Physician
- Palos Heights, IL
National Provider Identifier
1376650861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 36047506
- Practice address
- 12255 S 80TH Avenue
Suite 205
Palos Heights, IL 60463 - Phone
- (708) 923-7900
- Fax
- (708) 923-7915
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 36047506 | IL | Primary |
Addresses
Primary practice location
12255 S 80TH Avenue
Suite 205
Palos Heights, IL 60463
Mailing address
12255 S 80TH Avenue
Suite 205
Palos Heights, IL 60463
Phone (708) 923-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36047506 | IL | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376650861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12255 S 80TH AVENUE",
"address_2": "SUITE 205",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "60463",
"telephone_number": "708-923-7900",
"fax_number": "708-923-7915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12255 S 80TH AVENUE",
"address_2": "SUITE 205",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "60463",
"telephone_number": "708-923-7900",
"fax_number": "708-923-7915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVOSEL",
"first_name": "NICKOLA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "IL",
"license": "36047506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palos Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.