Provider Demographics
NPI:1518962091
Name:NICHOLS, WILLIAM (DPM)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-0426
Mailing Address - Country:US
Mailing Address - Phone:763-444-4111
Mailing Address - Fax:763-444-4488
Practice Address - Street 1:12940 HARRIET AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2680
Practice Address - Country:US
Practice Address - Phone:952-830-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN360213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106186OtherUCARE
MN0708630001OtherADMINASTAR
MN2728397OtherMEDICA
MN64D27NIOtherBCBS
MN113225300Medicaid
MNHP14063OtherHEALTH PARTNERS
MN980740974001OtherPREFERRED ONE
MN113225300Medicaid
MN106186OtherUCARE
MN0708630001OtherADMINASTAR