Individual
NICHOLAS JOHN NICKL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
740 S LIMESTONE, LEXINGTON, KY 40536-0001
(859) 323-5981
Mailing address
138 LEADER AVE, LEXINGTON, KY 40536-0001
(859) 257-7910
(859) 257-7899
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
26651
KY
207RG0100X
Gastroenterology Physician
Primary
26651
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64266513
—
KY
Enumeration date
07/25/2006
Last updated
11/28/2012
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