Individual
KARL F NICLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3535 PARK ST, SUITE 101, NORTON SHORES, MI 49444-3736
(231) 737-0411
(231) 739-8502
Mailing address
15455 148TH AVE, SPRING LAKE, MI 49456-9303
(616) 844-1576
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301069765
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4182350
—
MI
Enumeration date
08/10/2005
Last updated
02/21/2013
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