Provider Demographics
NPI:1235424862
Name:VORNEHM, NICHOLAS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:VORNEHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:VORNEHM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-736-7603
Mailing Address - Fax:317-736-7932
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2731
Practice Address - Country:US
Practice Address - Phone:317-736-7603
Practice Address - Fax:317-736-7932
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.016409208600000X
IN01073643A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201231660Medicaid
IN01073643AOtherINDIANA STATE LICENSE
IN01073643AOtherINDIANA STATE LICENSE