Individual
NICHOLAS GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1222 N 23RD ST, SHEBOYGAN, WI 53081-3171
(920) 457-6800
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
72979
WI
208M00000X
Hospitalist Physician
02005360A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100139705
—
WI
Enumeration date
04/21/2014
Last updated
12/11/2023
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