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General NPI Number Information
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NPI Number | 1497968655
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Entity Type | Individual
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Provider Name | NICHOLAS EUGENE MAKSIM D.O., R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 247 S BURNETT ROAD SUITE 120
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City | SPRINGFIELD
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State | OH
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Zip | 45505
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Country | US
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Telephone | 740-845-7700
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Fax | 740-845-7701
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Provider Business Mailing Address
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Address Line | 210 N MAIN STREET
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City | LONDON
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State | OH
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Zip | 43140-1115
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Country | US
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Telephone | 740-845-7700
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Fax | 740-845-7701
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 58-001639
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 34.009062
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 34009062
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License Number State | OH
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