Provider Demographics
NPI:1538693536
Name:LALIOS, NICHOLAS NICHOLAS (DPM)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:NICHOLAS
Last Name:LALIOS
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 1:7800 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4615
Mailing Address - Country:US
Mailing Address - Phone:219-808-0479
Mailing Address - Fax:
Practice Address - Street 1:7800 MADISON ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4615
Practice Address - Country:US
Practice Address - Phone:219-808-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000734A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist