Individual
JOHN DAVID NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
602 MICHIGAN AVE, HOLLAND, MI 49423
(616) 394-3522
Mailing address
PO BOX 30516, DEPT 4006, LANSING, MI 48909-8016
(616) 975-1845
(616) 975-1870
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301078807
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00161815
RAILROAD MEDICARE
MI
Enumeration date
05/11/2006
Last updated
05/25/2010
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