Healthcare Provider Details

I. General information

NPI: 1649701590
Provider Name (Legal Business Name): ANDREW MCNICOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 BRADENTON AVE STE A
DUBLIN OH
43017-7567
US

IV. Provider business mailing address

PO BOX 734439
CHICAGO IL
60673-4439
US

V. Phone/Fax

Practice location:
  • Phone: 614-777-5700
  • Fax: 614-389-3868
Mailing address:
  • Phone: 614-383-6450
  • Fax: 614-383-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35.144842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: