Provider Demographics
NPI:1629181490
Name:NICKELS, JOHN HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HARVEY
Last Name:NICKELS
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 1:2307 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3612
Mailing Address - Country:US
Mailing Address - Phone:216-687-4003
Mailing Address - Fax:216-687-4069
Practice Address - Street 1:2307 W 14TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3612
Practice Address - Country:US
Practice Address - Phone:216-687-4003
Practice Address - Fax:216-687-4069
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051581207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHO658640Medicaid
OHCO3399Medicare UPIN