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NPI Code Detail

MEDICARE: KENT A NICKELL M.D.

MEDICARE: KENT A NICKELL M.D.
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
1207ZP0101XAnatomic Pathology Physician32811IA
2207ZC0500XCytopathology Physician036148445IL

General Provider Information

NPI Number : 1942270004
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENT A NICKELL M.D.
Provider Business Mailing Address
First Line : 2400 N ROCKTON AVE
Second Line : MERCYHEALTH- ROCKFORD HEALTH PHYSICIANS
City : ROCKFORD
State : IL
Zip : 61103-3655
Country : US
Telephone Number : 815-971-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1825 LOGAN AVE
Second Line : NORTHEAST IOWA PATHOLOGY ASSOCIATES,PC
City : WATERLOO
State : IA
Zip : 50703-1916
Country : US
Telephone Number : 319-235-3679
Fax Number : 319-233-0722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 10/10/2023

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Directions to “ KENT A NICKELL M.D.” Practice Location

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