Provider Demographics
NPI:1952410219
Name:VIYUOH, NICHOLAS G (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:G
Last Name:VIYUOH
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 1:101 S PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5731
Mailing Address - Country:US
Mailing Address - Phone:580-379-6140
Mailing Address - Fax:580-379-6149
Practice Address - Street 1:525 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3313
Practice Address - Country:US
Practice Address - Phone:309-836-6937
Practice Address - Fax:309-836-6530
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18368207V00000X
PAMD430772207V00000X
IL036153809207V00000X
OK27537207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00259091Medicaid
OK200278140AMedicaid
AR152327001Medicaid
MS00259091Medicaid
AR152327001Medicaid
OK200278140AMedicaid