Individual
THOMAS G NILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2512 E DUPONT RD, SUITE 100, FORT WAYNE, IN 46825-1675
(260) 436-6667
(260) 918-2137
Mailing address
10351 DAWSONS CREEK BLVD, STE D, FORT WAYNE, IN 46825-1904
(260) 969-1950
(260) 918-2137
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01038992A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087515
ANTHEM BC/BS
IN
05
—
0748972
—
OH
05
—
0825398
—
OH
05
—
100081380
—
IN
05
—
100329810
—
IN
Enumeration date
02/14/2006
Last updated
02/29/2012
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