Individual
DR. NICHOLAS LEE NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1819 CAREW ST, FORT WAYNE, IN 46805-4705
(260) 373-7770
(260) 373-7775
Mailing address
205 TOWER DR, MONROE, IN 46772-9362
(260) 692-6163
(260) 728-3949
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01063067A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200970670
—
IN
Enumeration date
03/28/2007
Last updated
04/03/2026
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