Provider Demographics
NPI:1285896373
Name:NICHOLS, MIKE (MD)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14583 BIG BASIN WAY
Mailing Address - Street 2:#2B
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6072
Mailing Address - Country:US
Mailing Address - Phone:408-647-2130
Mailing Address - Fax:888-362-6713
Practice Address - Street 1:14583 BIG BASIN WAY
Practice Address - Street 2:#2B
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6072
Practice Address - Country:US
Practice Address - Phone:408-647-2130
Practice Address - Fax:888-362-6713
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49792208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice