Provider Demographics
NPI:1033149455
Name:RECCHIA, NICHOLAS G (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:G
Last Name:RECCHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:708-786-7100
Mailing Address - Fax:708-786-7101
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-786-7100
Practice Address - Fax:708-786-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208886987OtherTAX IDENTIFICATION NUMBER
IL036078622Medicaid
IL2215686OtherBLUE CROSS
ILK35994Medicare PIN