Provider Demographics
NPI:1326030446
Name:NICHOLAS, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21510 HARRINGTON ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2362
Mailing Address - Country:US
Mailing Address - Phone:586-627-1100
Mailing Address - Fax:586-627-1120
Practice Address - Street 1:21510 HARRINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-2362
Practice Address - Country:US
Practice Address - Phone:586-627-1100
Practice Address - Fax:586-627-1120
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICN013237207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4602688Medicaid
MI4602688Medicaid