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NPI Code Detail

MEDICARE: NICHOLAS EDMUND FOHL MD

MEDICARE: NICHOLAS EDMUND FOHL MD
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
1207Q00000XFamily Medicine Physician01035320AIN

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 : 1568445781
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS EDMUND FOHL MD
Provider Business Mailing Address
First Line : 8433 HARCOURT RD STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2195
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8433 HARCOURT RD STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2195
Country : US
Telephone Number : 317-338-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 08/29/2024

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