Individual
ROBERT J NICKODEM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7060 WAYSIDE DR, MTR1/-102, MENTOR, OH 44060-6527
(440) 357-2770
(440) 354-4669
Mailing address
7060 WAYSIDE DR, MTR1/-102, MENTOR, OH 44060-6527
(440) 357-2770
(440) 354-4669
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
35-05-1872-N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0594110
—
OH
Enumeration date
07/24/2006
Last updated
02/05/2013
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