Provider Demographics
NPI:1396989422
Name:ORWAR, NICOLE AIMEE (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:AIMEE
Last Name:ORWAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10260 191ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8801
Mailing Address - Country:US
Mailing Address - Phone:708-425-1907
Mailing Address - Fax:708-469-4358
Practice Address - Street 1:10260 191ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8801
Practice Address - Country:US
Practice Address - Phone:708-425-1907
Practice Address - Fax:708-469-4358
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2021-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400156315Medicare PIN