Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 45075 | MN |
N | 207RX0202X | Medical Oncology | 45075 | MN |
NPI | 1467482349 |
---|---|
Provider Name | Daniel Alan Nikcevich |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 09/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
085485900 | (05) | MN |
34258700 | (05) | WI |
G90723 | (02) |