Individual
NICOLE DAVIS RIORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(574) 647-7459
(574) 647-3658
Mailing address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(574) 647-7167
(574) 647-3671
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01065523A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000655105
ANTHEM
IN
05
—
200981060
—
IN
01
—
P00891626/CD
RR MEDICARE
IN
Enumeration date
06/18/2007
Last updated
06/27/2016
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