Provider Demographics
NPI:1447474283
Name:NIGRO, PHILLIP T (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:T
Last Name:NIGRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:6703 159TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1781
Practice Address - Country:US
Practice Address - Phone:708-429-0907
Practice Address - Fax:708-429-0802
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109031207X00000X
MA229348207X00000X
IL036.130530207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9845726OtherAETNA
FL344919OtherAVMED
FL9484418OtherCIGNA
FL14CN2OtherBCBS
FL14CN2OtherBCBS