Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2005-01034 | NC |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 6475000-1205 | UT |
NPI | 1598748725 |
---|---|
Provider Name | Dr. Florian Nickisch |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901362 | (05) | NC |
I17743 | (02) | NC |
N0103A | (05) | SC |