Basic Information
| Provider Information | |||||||||
| NPI: | 1700134087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EL HANGOUCHE | ||||||||
| FirstName: | NADIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 N LA SALLE DR APT 2104 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606101964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5713889086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 E MASON ST STE 4P57 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627011034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177880706 | ||||||||
| FaxNumber: | 2175252535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2012 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036.136412 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 390200000X | 125061782 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.