Individual
MARY H NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER RADIOLOGY GROUP, MUNSTER, IN 46321-2901
(219) 836-4569
Mailing address
9201 CALUMET AVE, MUNSTER, IN 46321-2807
(219) 836-2022
(219) 806-0034
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
01048811A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
0104881A
IN
Other
Enumeration date
08/23/2005
Last updated
03/18/2008
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