MEDICARE: DR. PIERRE PHILIPPE NICOLAS 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	208D00000X	General Practice Physician	ME 92302	FL

General Provider Information

NPI Number	:	1891784427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PIERRE PHILIPPE NICOLAS M.D.

Provider Business Mailing Address
First Line	:	671 NW 119TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-2522
Country	:	US
Telephone Number	:	305-688-0811
Fax Number	:	305-688-6304

Provider Business Practice Location Address
First Line	:	671 NW 119TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-2522
Country	:	US
Telephone Number	:	305-688-0811
Fax Number	:	305-688-6304

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	03/07/2023

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