Provider Demographics
NPI:1013947530
Name:NICHOLS, LUKE O (MD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:O
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:9211 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2968
Practice Address - Country:US
Practice Address - Phone:316-609-4400
Practice Address - Fax:316-634-4040
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS27107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100335940BMedicaid
KS81682OtherCOVENTRY
KS102900OtherHPK
KS12149442OtherMULTIPLAN
KS101029OtherBCBS
KS11984OtherPHS
KS101029OtherBCBS
KS102900OtherHPK