MEDICARE: DR. NIZHONI W DENIPAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD2018-0901	NM
2	207Y00000X	Otolaryngology Physician	35.155761	OH

General Provider Information

NPI Number	:	1003250069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIZHONI W DENIPAH M.D.

Provider Business Mailing Address
First Line	:	150 WASHINGTON AVE STE 201
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-2038
Country	:	US
Telephone Number	:	505-477-2200
Fax Number	:	505-782-1902

Provider Business Practice Location Address
First Line	:	2213 CHERRY ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2603
Country	:	US
Telephone Number	:	419-251-1020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/27/2026

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