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NPI Code Detail

MEDICARE: NICHOLAS THEODORE SEVERYN DO

MEDICARE: NICHOLAS THEODORE SEVERYN DO
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
12080N0001XNeonatal-Perinatal Medicine Physician02005617AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366897605
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS THEODORE SEVERYN DO
Provider Business Mailing Address
First Line : PO BOX 719094
Second Line :
City : CHICAGO
State : IL
Zip : 60677-9318
Country : US
Telephone Number : 317-777-6435
Fax Number : 317-777-6644
Provider Business Practice Location Address
First Line : 705 RILEY HOSPITAL DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5109
Country : US
Telephone Number : 317-274-4779
Fax Number : 317-948-9806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2016
Last Update Date : 07/02/2026

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Directions to “ NICHOLAS THEODORE SEVERYN DO” Practice Location

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