Provider Demographics
NPI:1437223807
Name:MAXWELL, NICHOLAS P (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:MAXWELL
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 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30316208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1006060OtherPHYSICIANS PLUS
690004890OtherMEDICARE RAILROAD
390808509OtherCIGNA
390808509OtherWPS
20022801OtherMEDICARE RAILROAD
390808509OtherCT GENERAL
90002361OtherWEA INS
10884OtherDEAN HEALTH PLAN
31508500OtherHIRSP
WI31508500Medicaid
39080850968OtherUNITY