Individual
NICHOLAS RICHARD LEVERGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 W MICHIGAN ST, INDIANAPOLIS, IN 46202-5209
(317) 274-2128
Mailing address
635 BARNHILL DR # MS 116, INDIANAPOLIS, IN 46202-5126
(317) 274-8282
(317) 278-3909
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01093315A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104332803
ANTHEM PTAN
IN
05
—
300051678
—
IN
Enumeration date
04/02/2020
Last updated
03/13/2025
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