MEDICARE: DR. MATTHEW DAVID NICHOLS DO

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
1	207Q00000X	Family Medicine Physician	OS19895	FL
2	207Q00000X	Family Medicine Physician	81951-21	WI

General Provider Information

NPI Number	:	1588292692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DAVID NICHOLS DO

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	888-987-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 W LAYTON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53321
Country	:	US
Telephone Number	:	414-508-2363
Fax Number	:	888-355-6740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	02/11/2026

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