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General NPI Number Information
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NPI Number | 1295881373
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Entity Type | Organization
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Legal Business Name | MICHAEL R NICHOLSON MD PLLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 5220 HIGHLAND RD SUITE 230
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City | WATERFORD
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State | MI
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Zip | 48327-1975
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Country | US
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Telephone | 248-456-8001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1481
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City | CLARKSTON
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State | MI
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Zip | 48347-1481
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Country | US
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Telephone | 248-456-8001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R NICHOLSON
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Credential | MD
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Telephone | 248-456-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | MI
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