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General NPI Number Information
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NPI Number | 1003830142
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Entity Type | Individual
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Provider Name | WILLIAM NICHOLSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2514 S 102ND ST STE 160
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City | WEST ALLIS
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State | WI
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Zip | 53227-2142
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Country | US
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Telephone | 414-255-0300
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Fax | 414-543-9601
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Provider Business Mailing Address
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Address Line | 3807 SPRING ST
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City | RACINE
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 262-687-8173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37383
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License Number State | WI
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