Provider Demographics
NPI:1205056967
Name:NICKOLOFF, STEVEN ERNST (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ERNST
Last Name:NICKOLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:555 S OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6658
Mailing Address - Country:US
Mailing Address - Phone:248-594-6330
Mailing Address - Fax:248-594-7465
Practice Address - Street 1:555 S OLD WOODWARD AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6658
Practice Address - Country:US
Practice Address - Phone:248-594-6330
Practice Address - Fax:248-594-7465
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010570222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM48530Medicare ID - Type Unspecified