Provider Demographics
NPI:1538133251
Name:MCNICOL, MICHAEL CRAIG (MIKE MCNICOL)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:MCNICOL
Suffix:
Gender:M
Credentials:MIKE MCNICOL
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:MCNICOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MIKE MCNICOL
Mailing Address - Street 1:865 JONATHAN LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1733
Mailing Address - Country:US
Mailing Address - Phone:740-364-0396
Mailing Address - Fax:
Practice Address - Street 1:314 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4483
Practice Address - Country:US
Practice Address - Phone:740-328-2228
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist