Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 4301106941 | MI |
Y | 207WX0107X | Retina Specialist | 4301106941 | MI |
NPI | 1003016916 |
---|---|
Provider Name | Dr. Benjamin P Nicholson |
First Address | Saint Joseph, MI 49085-3352 |
Second Address | Saint Joseph, MI 49085-3352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 27/03/2017 |