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NPI Code Detail

MEDICARE: MIKE NICHOLS M.D.

MEDICARE: MIKE NICHOLS 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
1208D00000XGeneral Practice PhysicianG49792CA

General Provider Information

NPI Number : 1285896373
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE NICHOLS M.D.
Provider Business Mailing Address
First Line : 14583 BIG BASIN WAY
Second Line : #2B
City : SARATOGA
State : CA
Zip : 95070-6072
Country : US
Telephone Number : 408-647-2130
Fax Number : 888-362-6713
Provider Business Practice Location Address
First Line : 14583 BIG BASIN WAY
Second Line : #2B
City : SARATOGA
State : CA
Zip : 95070-6072
Country : US
Telephone Number : 408-647-2130
Fax Number : 888-362-6713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2008
Last Update Date : 05/14/2009

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