Provider Demographics
NPI:1245354141
Name:NICHOLS, FREDERICK SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SCOTT
Last Name:NICHOLS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27472 SCHOENHERR RD
Mailing Address - Street 2:STE #150
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6688
Mailing Address - Country:US
Mailing Address - Phone:586-393-7777
Mailing Address - Fax:586-777-1533
Practice Address - Street 1:27472 SCHOENHERR RD
Practice Address - Street 2:STE #150
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6688
Practice Address - Country:US
Practice Address - Phone:586-393-7777
Practice Address - Fax:586-777-1533
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19026208600000X
MI5101016827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245354141Medicaid
1245354141Medicare UPIN