Provider Demographics
NPI:1669535027
Name:SANEZ, NICOLAS M (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:M
Last Name:SANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1479 E 84TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6451
Mailing Address - Country:US
Mailing Address - Phone:219-738-2828
Mailing Address - Fax:219-756-3349
Practice Address - Street 1:1479 E 84TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6451
Practice Address - Country:US
Practice Address - Phone:219-738-2828
Practice Address - Fax:219-756-3349
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01058167A208600000X
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021606444OtherBLUECROSSBLUESHIELD
IL0021606444OtherBLUECROSSBLUESHIELD