Individual
DR. DAVID W MCNICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
414 W VIRGINIA AVE, EFFINGHAM, IL 62401-2258
(217) 342-9738
(217) 342-9806
Mailing address
PO BOX 1169, EFFINGHAM, IL 62401-1169
(217) 342-9738
(217) 342-9806
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0361036581
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361036581
—
IL
01
—
068148
HEALTHALLIANCE
IL
01
—
2500053
BCBS
IL
01
—
340018705
RAILROAD MEDICARE IDENT.#
IL
01
—
451985
HEALTHLINK
IL
01
—
CC9824
RAILROAD MEDICARE
IL
Enumeration date
04/18/2006
Last updated
03/03/2008
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