Individual
J TIMOTHY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
101 N GIRLS SCHOOL RD, INDIANAPOLIS, IN 46214-3963
(317) 247-0201
(317) 481-6756
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000537A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000081248
BLUE CROSS BLUE SHIELD
IN
05
—
100062200
—
IN
01
—
P01391909
RAIL ROAD PTAN
IN
Enumeration date
06/23/2005
Last updated
06/11/2015
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