Provider Demographics
NPI:1871048058
Name:NILSEN, ANNIKA M (MD)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:M
Last Name:NILSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR STE 810
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8700
Mailing Address - Country:US
Mailing Address - Phone:312-926-8811
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 810
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8700
Practice Address - Country:US
Practice Address - Phone:312-926-8811
Practice Address - Fax:312-926-8855
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036170533207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty