Provider Demographics
NPI:1871604173
Name:WALICKI, NAN O (MD)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:O
Last Name:WALICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAN
Other - Middle Name:
Other - Last Name:OESTERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1430 N ARLINGTON HTS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4830
Mailing Address - Country:US
Mailing Address - Phone:847-253-3600
Mailing Address - Fax:847-253-3912
Practice Address - Street 1:1430 N ARLINGTON HTS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-253-3600
Practice Address - Fax:847-253-3912
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics