Provider Demographics
NPI:1538696620
Name:DEL PICCOLO, NICO RENZO (MD)
Entity type:Individual
Prefix:
First Name:NICO
Middle Name:RENZO
Last Name:DEL PICCOLO
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 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:1400 S LAKE PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6791
Practice Address - Country:US
Practice Address - Phone:219-947-6690
Practice Address - Fax:219-947-6125
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLSTUDENT208600000X
FLTRN25320208600000X
IN01088380A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program