Individual
DR. NICHOLAS DEFAUW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1111 LIGHTHOUSE LN, GOSHEN, IN 46526-3824
(260) 266-4007
(260) 266-7355
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02005770A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02005770A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300029326
—
IN
Enumeration date
07/01/2009
Last updated
05/04/2026
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