Provider Demographics
NPI:1801382551
Name:NICHOLS, AARON (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:NICHOLS
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 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4830
Mailing Address - Fax:517-432-2134
Practice Address - Street 1:4650 S HAGADORN RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5386
Practice Address - Country:US
Practice Address - Phone:517-353-4830
Practice Address - Fax:517-355-2134
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301505400207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI43011161645315094613OtherMEDICAL DOCTOR - EDUCATION LIMITED