Individual
MICHAEL DUSTIN NICOLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1420 KEY HWY # 400, BALTIMORE, MD 21230-5546
(730) 639-7480
Mailing address
613 S BAYSHORE BLVD, SAFETY HARBOR, FL 34695-4003
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D93130
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
12/05/2022
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