Healthcare Provider Details

I. General information

NPI: 1922047778
Provider Name (Legal Business Name): MICHAEL R NILL MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 BENEDICT AVE
NORWALK OH
44857-2374
US

IV. Provider business mailing address

272 BENEDICT AVE
NORWALK OH
44857-2374
US

V. Phone/Fax

Practice location:
  • Phone: 419-668-8101
  • Fax: 419-660-2686
Mailing address:
  • Phone: 419-668-8101
  • Fax: 419-660-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.065471
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: