Provider Demographics
NPI:1124026059
Name:NICHOLAS, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9615 E 148TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4360
Mailing Address - Country:US
Mailing Address - Phone:317-587-0500
Mailing Address - Fax:317-674-0059
Practice Address - Street 1:2506 WILLOWBROOK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1564
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0059
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01036176A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100353310Medicaid
IN100353310Medicaid
IN945920JMedicare PIN