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NPI Code Detail

MEDICARE: NICHOLAS L. RICO, M.D., P.C.

MEDICARE: NICHOLAS L. RICO, M.D., P.C.
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 Physician01031164AIN

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 : 1710062690
Entity Type Code : Organization
Provider Name (Legal Business Name) : NICHOLAS L. RICO, M.D., P.C.
Provider Business Mailing Address
First Line : 3303 TRIER RD STE 1
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4768
Country : US
Telephone Number : 260-483-4260
Fax Number : 260-483-6066
Provider Business Practice Location Address
First Line : 3303 TRIER RD STE 1
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4768
Country : US
Telephone Number : 260-483-4260
Fax Number : 260-483-6066
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : NICHOLAS L. RICO
Credential : M.D.
Telephone Number : 260-483-4260
Provider Enumeration Date : 10/26/2006
Last Update Date : 12/08/2009

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