Provider Demographics
NPI:1811948672
Name:NICKLES, WILLIAM A (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:NICKLES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00766213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
118341OtherHEALTH ALLIANCE
IA01C1OtherJOHN DEERE HEALTH CARE /
IA0491662Medicaid
IA15422OtherWELLMARK BC/BS
250822OtherMIDLANDS CHOICE
250822OtherMIDLANDS CHOICE
IA01C1OtherJOHN DEERE HEALTH CARE /
V09531Medicare UPIN
IABN9116535OtherDEA REGISTRATION NUMBER
IA0491662Medicaid