Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12012949A | IN |
Y | 213EG0000X | General Practice | 12012949A | IN |
NPI | 1003300336 |
---|---|
Provider Name | Mr. Thomas Steven Nichols |
First Address | Merrillville, IN 46410-6452 |
Second Address | Merrillville, IN 46410-6452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 20/06/2018 |