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NPI Code Detail

MEDICARE: NICCI M. PITTMAN M.D.

MEDICARE: NICCI M. PITTMAN 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
1207Q00000XFamily Medicine Physician31824KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080140770OTHERKYRR MEDICARE PIN
24000501OTHERKYMEDICARE LAB GROUP
4CB5773OTHERKYRR MEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912932039
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICCI M. PITTMAN M.D.
Provider Business Mailing Address
First Line : 3085 LAKECREST CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1707
Country : US
Telephone Number : 859-258-8600
Fax Number : 859-258-8610
Provider Business Practice Location Address
First Line : 3085 LAKECREST CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1707
Country : US
Telephone Number : 859-258-8600
Fax Number : 859-258-8610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 03/30/2016

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