Individual
NICHOLAS L RICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1818 CAREW ST STE 120, FORT WAYNE, IN 46805-4764
(260) 425-6200
(260) 425-6205
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01031164A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080192526
RAILROAD MEDICARE
IN
05
—
100079790A
—
IN
Enumeration date
03/29/2007
Last updated
12/23/2021
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