Provider Demographics
NPI:1285620120
Name:VAN ES, NICOLAS JON (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:JON
Last Name:VAN ES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1105 E HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1426
Practice Address - Country:US
Practice Address - Phone:605-582-5820
Practice Address - Fax:605-582-5823
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34204207Q00000X
SD6008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35067OtherWELLMARK BC/BS
IA5213975Medicaid
IAP00050397OtherRAILROAD MEDICARE
IAP00050397OtherRAILROAD MEDICARE
SDP00395018Medicare PIN
IAH40514Medicare UPIN