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General NPI Number Information
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NPI Number | 1538696620
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Entity Type | Individual
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Provider Name | NICO RENZO DEL PICCOLO MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 1400 S LAKE PARK AVE STE 202
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City | HOBART
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State | IN
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Zip | 46342-6791
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Country | US
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Telephone | 219-947-6690
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Fax | 219-947-6125
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | STUDENT
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TRN25320
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01088380A
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License Number State | IN
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