Provider Demographics
NPI:1497848626
Name:MCNICHOL, MILTON (MD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:MCNICHOL
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 1:1000 N MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8406
Mailing Address - Country:US
Mailing Address - Phone:407-345-9006
Mailing Address - Fax:407-345-9007
Practice Address - Street 1:1000 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8406
Practice Address - Country:US
Practice Address - Phone:407-345-9006
Practice Address - Fax:407-345-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0431328207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70205Medicare UPIN
KS35669017OtherBLUE CROSS