Healthcare Provider Details

I. General information

NPI: 1407040918
Provider Name (Legal Business Name): TIM NICE M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34600 CHARDON ROAD SUITE 9
WILLOUGHBY HILLS OH
44094
US

IV. Provider business mailing address

34600 CHARDON ROAD SUITE 9
WILLOUGHBY HILLS OH
44094
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-5258
  • Fax: 440-944-5278
Mailing address:
  • Phone: 440-585-5258
  • Fax: 440-944-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35036891
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIM J NICE
Title or Position: DOCTOR
Credential: M.D.
Phone: 440-585-5258