Individual
DR. DAVID ERNEST NICCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
640 JACKSON ST, MS 11502B, ST. PAUL, MN 55101-2502
(651) 254-3135
(651) 254-3048
Mailing address
8170 33RD AVE S, MS 21110Q, MINNEAPOLIS, MN 55425-0341
(651) 254-3048
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
56658
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2008
Last updated
03/17/2018
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