Provider Demographics
NPI:1467509620
Name:NICHOLAS, LUKE C (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:C
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3434 RIVERTOWN POINT CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3076
Mailing Address - Country:US
Mailing Address - Phone:616-257-3344
Mailing Address - Fax:616-257-1491
Practice Address - Street 1:750 E BELTLINE AVE NE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6046
Practice Address - Country:US
Practice Address - Phone:616-942-9343
Practice Address - Fax:616-942-2538
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301101878207N00000X, 207ND0101X
MDD0082362207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology