MEDICARE: DR. NICOLE RACHEL DOMINIAK 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35.131515	OH
2	207ND0900X	Dermatopathology Physician	35.131515	OH
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	LL 34849	SC

General Provider Information

NPI Number	:	1417210261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE RACHEL DOMINIAK M.D.

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-3472
Fax Number	:	419-383-6130

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	02/11/2026

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