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NPI Code Detail

MEDICARE: DR. MARK W NICKELS M.D.

MEDICARE: DR. MARK W NICKELS 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
1207R00000XInternal Medicine PhysicianME152102FL

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 : 1679520837
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK W NICKELS M.D.
Provider Business Mailing Address
First Line : 101 RIVERFRONT BLVD STE 710
Second Line :
City : BRADENTON
State : FL
Zip : 34205-8812
Country : US
Telephone Number : 941-776-4000
Fax Number :
Provider Business Practice Location Address
First Line : 12271 US HIGHWAY 301 N
Second Line :
City : PARRISH
State : FL
Zip : 34219-8410
Country : US
Telephone Number : 941-776-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 11/07/2023

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