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NPI Code Detail

MEDICARE: DR. JEFFREY R NICKEL MD

MEDICARE: DR. JEFFREY R NICKEL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician01041599AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000082554OTHERINANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000004726OTHERMPLAN
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265427116
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY R NICKEL MD
Provider Business Mailing Address
First Line : 608 UNION CHAPEL RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9357
Country : US
Telephone Number : 260-482-4440
Fax Number : 260-482-4442
Provider Business Practice Location Address
First Line : 2200 RANDALLIA DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4638
Country : US
Telephone Number : 260-373-4000
Fax Number : 260-482-4442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 06/25/2026

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