Provider Demographics
NPI:1295718070
Name:NICOLAU, MARTIN F (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:F
Last Name:NICOLAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:9776 BONITA BEACH RD SE
Practice Address - Street 2:#201A
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4773
Practice Address - Country:US
Practice Address - Phone:239-947-3092
Practice Address - Fax:239-947-1077
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80435207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830006897OtherRR MEDICARE
FL259862100Medicaid
FLH16303Medicare UPIN
FLE4149WMedicare PIN
FL259862100Medicaid
FLE4149ZMedicare PIN