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General NPI Number Information
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NPI Number | 1558438788
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Entity Type | Individual
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Provider Name | THOMAS LOUIS NICKOLAS MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 4921 PARKVIEW PL DIV IM BONE AND MINERAL, STE 5C
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1032
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Country | US
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Telephone | 314-454-7775
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Fax | 314-996-3087
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-454-7775
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Fax | 314-996-3087
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 2024049980
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 2024049980
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License Number State | MO
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