Provider Demographics
NPI:1780115568
Name:ELWERT, NICHOLAS CHARLES (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:ELWERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1405
Mailing Address - Country:US
Mailing Address - Phone:859-257-4890
Mailing Address - Fax:859-323-1123
Practice Address - Street 1:2050 VERSAILLES RD
Practice Address - Street 2:STE U102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-257-4888
Practice Address - Fax:859-323-1123
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4413208100000X
KY04943208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation