MEDICARE: TANN A NICHOLS MD

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	207T00000X	Neurological Surgery Physician	35.090865	OH
2	207T00000X	Neurological Surgery Physician	41374	KY

General Provider Information

NPI Number	:	1932384930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANN A NICHOLS MD

Provider Business Mailing Address
First Line	:	PO BOX 643398
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45264-3398
Country	:	US
Telephone Number	:	513-221-1100
Fax Number	:	513-569-5297

Provider Business Practice Location Address
First Line	:	544 CENTRE VIEW BLVD
Second Line	:
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-3400
Country	:	US
Telephone Number	:	513-221-1100
Fax Number	:	859-341-3913

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	05/26/2020

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Directions to “ TANN A NICHOLS MD” Practice Location

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