Basic Information
| Provider Information | |||||||||
| NPI: | 1447474283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIGRO | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27702 NETWORK PL | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606731277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088627674 | ||||||||
| FaxNumber: | 7088621781 | ||||||||
| Practice Location | |||||||||
| Address1: | 6703 159TH ST | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084290907 | ||||||||
| FaxNumber: | 7084290802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME109031 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 229348 | MA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 036.130530 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 9845726 | 01 | FL | AETNA | OTHER | 344919 | 01 | FL | AVMED | OTHER | 9484418 | 01 | FL | CIGNA | OTHER | 14CN2 | 01 | FL | BCBS | OTHER |