Individual
DR. MICHAEL D. NICKELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2040 W. 32ND ST, JOPLIN, MO 64804
(417) 627-1300
(417) 627-1357
Mailing address
2040 W. 32ND ST, JOPLIN, MO 64804
(417) 627-1300
(417) 627-1357
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
R9A40
MO
208M00000X
Hospitalist Physician
Primary
R9A40
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20896
BNDD
MO
Enumeration date
09/21/2005
Last updated
04/17/2009
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