Provider Demographics
NPI:1154325439
Name:MONSUL, NICHOLAS THEMIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THEMIS
Last Name:MONSUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2307
Mailing Address - Country:US
Mailing Address - Phone:941-953-5050
Mailing Address - Fax:941-343-8021
Practice Address - Street 1:2068 HAWTHORNE ST
Practice Address - Street 2:STE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2307
Practice Address - Country:US
Practice Address - Phone:941-953-5050
Practice Address - Fax:941-343-8021
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME868082082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57637WMedicare PIN
FLH20876Medicare UPIN