Provider Demographics
NPI:1891766739
Name:NUKES, THEODORE ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ALEXANDER
Last Name:NUKES
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 1:13400 N MERIDIAN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13400 N MERIDIAN ST STE 304
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7103
Practice Address - Country:US
Practice Address - Phone:317-582-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010428072084N0400X, 2084N0400X
IN01042807A2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN129480500OtherDEPT OF LABOR
IN200015060AMedicaid
IN000000091274OtherANTHEM
IN4513460OtherAETNA
IN130013529OtherRR MEDICARE
IN000000091274OtherANTHEM
IN815150KKKMedicare PIN
IN130013529OtherRR MEDICARE
IN4513460OtherAETNA
IN815150KKKMedicare PIN