Provider Demographics
NPI:1184291338
Name:LIQUIGLI, NICHOLAS JOSEPH COLLETTI (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSEPH COLLETTI
Last Name:LIQUIGLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:220 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4608
Mailing Address - Country:US
Mailing Address - Phone:616-685-5050
Mailing Address - Fax:
Practice Address - Street 1:220 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4608
Practice Address - Country:US
Practice Address - Phone:616-685-5050
Practice Address - Fax:616-685-8962
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51510151292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology