Individual
DR. JEFFREY R NICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-4000
(260) 482-4442
Mailing address
3640 NEW VISION DRIVE, SUITE A, FORT WAYNE, IN 46845-1717
(260) 482-4440
(260) 482-4442
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01041599A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000004726
MPLAN
—
01
—
000000082554
ANTHEM
IN
05
—
104874490
—
MI
05
—
200027530
—
IN
05
—
2516272
—
OH
Enumeration date
09/16/2005
Last updated
05/10/2013
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