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NPI Code Detail

MEDICARE: MATTHEW PAUL NICKEL LLP

MEDICARE: MATTHEW PAUL NICKEL LLP
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
1103TC2200XClinical Child & Adolescent Psychologist6361008105MI
2103T00000XPsychologist6361008105MI

General Provider Information

NPI Number : 1679357032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW PAUL NICKEL LLP
Provider Business Mailing Address
First Line : 2075 W BIG BEAVER RD STE 520
Second Line :
City : TROY
State : MI
Zip : 48084-3442
Country : US
Telephone Number : 248-646-6659
Fax Number :
Provider Business Practice Location Address
First Line : 2075 W BIG BEAVER RD STE 520
Second Line :
City : TROY
State : MI
Zip : 48084-3442
Country : US
Telephone Number : 248-646-6659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2023
Last Update Date : 03/23/2026

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Directions to “ MATTHEW PAUL NICKEL LLP” Practice Location

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