Provider Demographics
NPI:1649920588
Name:TOMCZUK, NICOLE (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TOMCZUK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JAMANDRON
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 S WAUKEGAN RD # 200
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5239
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:
Practice Address - Street 1:350 S WAUKEGAN RD STE 200
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5239
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:224-271-4332
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036176438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program