Provider Demographics
NPI:1750522660
Name:WINTERS, NICOLAUS D (MD)
Entity type:Individual
Prefix:
First Name:NICOLAUS
Middle Name:D
Last Name:WINTERS
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:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-409-9925
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:700 KIMBER LANE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2803
Practice Address - Country:US
Practice Address - Phone:812-476-7111
Practice Address - Fax:812-476-7117
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46334207LP2900X
IL036149268207LP2900X
IN01074139207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQZZ000000165167OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
ILP02271332OtherRAILROAD MEDICARE
1564011OtherCIGNA PROVIDER ID NUMBER
KYP01590222OtherRAILROAD MEDICARE
IL036149268Medicaid
INP01607483OtherRAILROAD MEDICARE
000000955100OtherANTHEM PIN
KY1232425OtherWELLCARE OF KY PROVIDER ID NUMBER
IN201249440Medicaid
CS1604700123OtherCARESOURCE ID
005120936OtherUNITED HEALTHCARE PROVIDER ID
KY7100388050Medicaid
7638957OtherAETNA PIN