Individual
ROWAN REECE NICKOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
47329
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0240840
GR MEDICAID NUMBER
OH
05
—
0572983
—
OH
01
—
MI9912194
GR MEDICARE NUMBER
—
Enumeration date
08/12/2005
Last updated
11/27/2013
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