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NPI Code Detail

MEDICARE: DR. NICOLAS K. FLETCHER MD

MEDICARE: DR. NICOLAS K. FLETCHER 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
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry Physician4351048761MI

General Provider Information

NPI Number : 1598342511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLAS K. FLETCHER MD
Provider Business Mailing Address
First Line : 138 ALGER ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-3407
Country : US
Telephone Number : 301-257-2152
Fax Number :
Provider Business Practice Location Address
First Line : 3031 W GRAND BLVD STE 600
Second Line :
City : DETROIT
State : MI
Zip : 48202-3014
Country : US
Telephone Number : 313-346-5235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 07/22/2021

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