Healthcare Provider Details

I. General information

NPI: 1629459482
Provider Name (Legal Business Name): NICHOLAUS MIZE D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 29TH ST STE 202
LOVELAND CO
80538-2746
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7050
  • Fax: 970-203-7055
Mailing address:
  • Phone: 970-203-7050
  • Fax: 970-203-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0061867
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: