Individual
RICHARD K NICCUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
3460 N STATE ROAD 109, COLUMBIA CITY, IN 46725-8953
(260) 229-1714
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01037769A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200210570
—
IN
Enumeration date
05/11/2006
Last updated
05/22/2013
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