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General NPI Number Information
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NPI Number | 1962683581
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Entity Type | Individual
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Provider Name | NICHOLAS JOSEPH VAN SICKELS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 3101 BEAUMONT CENTRE CIR STE 100
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City | LEXINGTON
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State | KY
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Zip | 40513-1959
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Country | US
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Telephone | 859-323-5544
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Fax | 859-257-9286
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Provider Business Mailing Address
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Address Line | 1631 ELYSIAN FIELDS AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70117-8208
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Country | US
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Telephone | 504-821-2601
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Fax | 504-814-6047
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD.201407
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.201407
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD.201407
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 56921
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License Number State | KY
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