Provider Demographics
NPI:1346282126
Name:KONDELIS, NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KONDELIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CLEARWATER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1931
Mailing Address - Country:US
Mailing Address - Phone:630-581-3801
Mailing Address - Fax:630-607-1002
Practice Address - Street 1:2100 CLEARWATER DR STE 100
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1931
Practice Address - Country:US
Practice Address - Phone:630-607-1000
Practice Address - Fax:630-607-1002
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070815207L00000X, 207LP2900X, 208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070815Medicaid
IL02233277OtherBLUE SHIELD OF ILLINOIS
C48627Medicare UPIN