1538133251 NPI number — MR. MICHAEL CRAIG MCNICOL MIKE MCNICOL

Table of content: MR. MICHAEL CRAIG MCNICOL MIKE MCNICOL (NPI 1538133251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538133251 NPI number — MR. MICHAEL CRAIG MCNICOL MIKE MCNICOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNICOL
Provider First Name:
MICHAEL
Provider Middle Name:
CRAIG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MIKE MCNICOL
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNICOL
Provider Other First Name:
MIKE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MIKE MCNICOL
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538133251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 JONATHAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43055-1733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-364-0396
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 GRANVILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-4483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-328-2228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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