Provider Demographics
NPI:1417020504
Name:RETSON, NICHOLAS CHRIS (MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:CHRIS
Last Name:RETSON
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 1:8053 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5303
Mailing Address - Country:US
Mailing Address - Phone:219-769-4456
Mailing Address - Fax:
Practice Address - Street 1:8053 CLEVELAND PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5303
Practice Address - Country:US
Practice Address - Phone:219-769-4456
Practice Address - Fax:219-769-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026350208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100339140AMedicaid
IN0000000184599OtherANTHEM
IN100339140AMedicaid
IN0000000184599OtherANTHEM
INB28829Medicare UPIN