Healthcare Provider Details

I. General information

NPI: 1952410219
Provider Name (Legal Business Name): NICHOLAS G VIYUOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E GRANT ST
MACOMB IL
61455-3313
US

IV. Provider business mailing address

101 S PARK LN
ALTUS OK
73521-5731
US

V. Phone/Fax

Practice location:
  • Phone: 309-836-6937
  • Fax: 309-836-6530
Mailing address:
  • Phone: 580-379-6140
  • Fax: 580-379-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18368
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD430772
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036153809
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27537
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: