Provider Demographics
NPI:1952313215
Name:FINLEY, NICHOLAS L (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:L
Last Name:FINLEY
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3513
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:2235 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3212
Practice Address - Country:US
Practice Address - Phone:574-267-8189
Practice Address - Fax:574-267-7554
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061059207P00000X
IN01061059A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01072417OtherRAILROAD MEDICARE
21415OtherPHP
IN200527420Medicaid
INP00418789OtherRAILROAD MEDICARE
INM400074566Medicare PIN
INP00418789OtherRAILROAD MEDICARE
IN200527420Medicaid
INP01072417OtherRAILROAD MEDICARE