Healthcare Provider Details

I. General information

NPI: 1417020504
Provider Name (Legal Business Name): NICHOLAS CHRIS RETSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8053 CLEVELAND PL
MERRILLVILLE IN
46410-5303
US

IV. Provider business mailing address

8053 CLEVELAND PL
MERRILLVILLE IN
46410-5303
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-4456
  • Fax: 219-769-1468
Mailing address:
  • Phone: 219-769-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01026350
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number01026350
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: