Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | 01074143A | IN |
Y | 2082S0105X | Plastic Hand Surgeon | 47277 | KY |
NPI | 1275738171 |
---|---|
Provider Name | Michael Carl Nicoson |
First Address | Louisville, KY 40207-1852 |
Second Address | Louisville, KY 40223-4154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/01/2015 |