Provider Demographics
NPI:1356557771
Name:NICHOLAS, KREMER B (MD)
Entity type:Individual
Prefix:
First Name:KREMER
Middle Name:B
Last Name:NICHOLAS
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 1:3633 CENTRAL AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6475
Mailing Address - Country:US
Mailing Address - Phone:501-623-6693
Mailing Address - Fax:501-623-9403
Practice Address - Street 1:3633 CENTRAL AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6475
Practice Address - Country:US
Practice Address - Phone:501-623-6693
Practice Address - Fax:501-623-9403
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-63712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183666001Medicaid
AR5AD92Medicare PIN
AR955815Medicare UPIN