Individual
MICHAEL A NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
160 CORNWALL DR, CRETE, IL 60417-1006
(708) 297-0499
Mailing address
160 CORNWALL DR, CRETE, IL 60417-1006
(708) 297-0499
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
02000901A
IN
207RI0011X
Interventional Cardiology Physician
Primary
02000901A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095311
ANTHEM PIN
IN
01
—
060030029
RR MEDICARE
—
Enumeration date
12/09/2005
Last updated
01/20/2026
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