BRIAN NICKOLOFF (NPI# 1104806272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104806272 |
| Entity Type | Individual |
| Full Name | BRIAN NICKOLOFF |
| Credential | MD PHD |
| Practice Address |
2160 S First Ave (ems Bldg., Rm. 2209) Maywood IL 60153 |
| Practice Telephone | 7082163250 |
| Practice Fax Number | 7082162620 |
| Mailing Telephone | 7082163250 |
| Mailing Fax Number | 7082162620 |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2010-03-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZD0900X |
Pathology Specialization: Dermatopathology |
36092377 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 36092377 | 05 |
| Street Address |
2160 S FIRST AVE (EMS BLDG., RM. 2209) |
| City | MAYWOOD |
| State | IL |
| Zip Code | 60153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497732747 | Rodney Tehrani | Internal Medicine | 2160 S First Ave, (luh-north Ent., Rm. 7604), Maywood, IL 60153 | 2005-12-28 |
| 1013448901 | Erin Rebecca Fiedler | Psychiatry & Neurology | 2160 S First Ave, Loyola University Medical Gme Office 105/2840, Maywood, IL 60153 | 2017-03-23 |
| 1477917698 | Judy A Trieu | Internal Medicine | 2160 S First Ave, Building 54- Suite 167, Maywood, IL 60153 | 2016-04-13 |
| 1285977348 | Mackenzie Marie Sward | Ophthalmology | 2160 S First Ave, Loyola University Medical Center Dept of Ophthalmology, Maywood, IL 60153-6809 | 2013-03-27 |
| 1689822231 | Sean O'donnell | Surgery | 2160 S First Ave, Loyola Medical Center Department of Surgery, Maywood, IL 60153 | 2008-09-08 |
| 1730336652 | Lara Bakhos | Internal Medicine | 2160 S First Ave, Maywood, IL 60153 | 2008-08-21 |
| 1831353788 | Justin Spackey | Radiology | 2160 S First Ave, Maywood, IL 60153 | 2008-07-10 |
| 1821257833 | Neha Sheth Dasmunshi | Anesthesiology | 2160 S First Ave, Maywood, IL 60153-3328 | 2008-06-04 |
| 1629290655 | Mark E Cichon | Emergency Medicine | 2160 S First Ave, Ems Bldg. Rm. 2700, Maywood, IL 60153 | 2007-05-02 |
| 1396878682 | Donna Mccormack | Nurse Practitioner | 2160 S First Ave, 101 1740 Loyola University Medical Center, Maywood, IL 60153 | 2007-03-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053933077 | Judie Noemie Hoilat | Internal Medicine | 2160 S 1st Avenue, Maywood, IL 60153 | 2020-05-13 |
| 1457972457 | Yuchen Zheng | Student in an Organized Health Care Education/Training Program | Department of Neurology, Loyola University Medical Cent, 2160 S. First Ave, Maywood, IL 60153 | 2020-04-30 |
| 1437779519 | Amna Amad Siddiqui | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue, Loyola University Medical Center, Maywood, IL 60153 | 2020-04-20 |
| 1982232211 | Brian Kurtz | Student in an Organized Health Care Education/Training Program | 2160 S First Ave, Bulding 105-suite 2840a, Maywood, IL 60153 | 2020-03-31 |
| 1902434947 | Saadiya Jabbar | Psychiatry & Neurology | Loyola University Medical Center, Building 105, Suite 1940, Maywood, IL 60153 | 2020-03-27 |
| 1558919472 | Linda Sue Moton | Technician | 10 South 15 Apt. 1, Maywood, IL 60153 | 2019-09-04 |
| 1760047518 | Braden Robert Dasovic | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue Building 105/room 2700, Department, Loyola Medical Center, Maywood, IL 60153 | 2019-05-07 |
| 1134680713 | Madeline Shaoyun Tiee | Orthopaedic Surgery | Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 | 2019-03-27 |
| 1538629746 | Michael Murphy | Orthopaedic Surgery | 2160 S 1st Ave., Maguire Center, Dept of Ortho Surg, Maywood, IL 60153 | 2019-03-22 |
| 1053871681 | Michael V Padua | Psychiatry & Neurology | 2160 S 1st Ave Bldg, Maywood, IL 60153 | 2019-03-20 |
| Find all providers in zip 60153 | ||||
| Taxonomy Code | 207ZD0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Dermatopathology |
| A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source added] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. A subspecialty certificate was first issued by the ABMS in 1974. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023332467 | Jodi J Speiser | Pathology | 2160 S 1st Ave, Department of Pathology, Maywood, IL 60153-3328 | 2010-03-14 |
| 1134224645 | Darryl Alan Oble | Pathology | 2160 S 1st Ave, Loyola University Medical Center, Dept. of Pathology, Maywood, IL 60153-3328 | 2006-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811204399 | Seema Pasha Apichai | Pathology | 7123 West Archer Ave, Chicago, IL 60638 | 2010-09-07 |
| 1558519454 | Devon Collins Gimbel | Pathology | 28100 N Ashley Cir, Ste 106, Libertyville, IL 60048-9478 | 2008-09-04 |
| 1174599260 | Chen Wang | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-02-27 |
| 1063846368 | Lohini Sundharkrishnan | Pathology | 5841 S Maryland Ave # Mc5067, Chicago, IL 60637-1447 | 2013-08-22 |
| 1134481054 | Nour Almardini | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4689 | 2012-06-15 |
| 1861790362 | Eugen Catalin Minca | Pathology | 2155 City Gate Ln, Naperville, IL 60563-7733 | 2011-03-07 |
| 1134310964 | Patricia Margaret Fishman | Pathology | 1740 W Taylor St, Chicago, IL 60612-7232 | 2007-08-07 |
| 1356567044 | Adam M Quinn | Pathology | 5409 N Knoxville Ave, Peoria, IL 61614-5069 | 2007-04-18 |
| 1386681906 | Marylee Braniecki | Pathology | Lutheran General Hospital / Pathology Department, 1775 Dempster Street, Park Ridge, IL 60068 | 2006-06-01 |
| 1710931670 | Soderstrom Dermatology Center S C | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-05-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.