Individual
DR. DAVID A. NICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 MEDICAL PLZ STE 310, LAKE ST LOUIS, MO 63367-1484
(636) 625-2662
Mailing address
PO BOX 955534 SUITE 310, SAINT LOUIS, MO 63195-0001
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2000153513
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205420805
—
MO
Enumeration date
03/30/2006
Last updated
10/26/2020
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