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General NPI Number Information
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NPI Number | 1528461720
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Entity Type | Organization
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Legal Business Name | KYLE NICKEL MD, PC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 95 STAFFORD LN
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City | DELTA
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State | CO
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Zip | 81416-3465
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Country | US
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Telephone | 970-874-8026
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Fax |
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Provider Business Mailing Address
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Address Line | 95 STAFFORD LN
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City | DELTA
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State | CO
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Zip | 81416-3465
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Country | US
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Telephone | 970-874-8026
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYLE CHRISTIAN NICKEL
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Credential | M.D.
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Telephone | 303-929-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 33012
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License Number State | CO
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