Provider Demographics
NPI:1891784427
Name:NICOLAS, PIERRE PHILIPPE (MD)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:PHILIPPE
Last Name:NICOLAS
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 1:671 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2522
Mailing Address - Country:US
Mailing Address - Phone:305-688-0811
Mailing Address - Fax:305-688-6304
Practice Address - Street 1:671 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2522
Practice Address - Country:US
Practice Address - Phone:305-688-0811
Practice Address - Fax:305-688-6304
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92302208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBN8234267OtherDEA
FLI 27573Medicare UPIN
FLBN8234267OtherDEA