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General NPI Number Information
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NPI Number | 1144285826
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Entity Type | Individual
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Provider Name | DAVID W MCNICHOLS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 414 W VIRGINIA AVE
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City | EFFINGHAM
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State | IL
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Zip | 62401-2258
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Country | US
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Telephone | 217-342-9738
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Fax | 217-342-9806
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Provider Business Mailing Address
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Address Line | PO BOX 1169
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City | EFFINGHAM
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State | IL
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Zip | 62401-1169
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Country | US
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Telephone | 217-342-9738
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Fax | 217-342-9806
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0361036581
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License Number State | IL
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