Basic Information
| Provider Information | |||||||||
| NPI: | 1306334628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAFATI | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | AIDA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 E OHIO ST APT 2402 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864494191 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 777 PARK AVE W | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600352433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702530 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2018 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 036156549 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 036156549 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.