Provider Demographics
NPI:1699738567
Name:NICKEL, KYLE CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:CHRISTIAN
Last Name:NICKEL
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 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-874-8026
Mailing Address - Fax:
Practice Address - Street 1:95 STAFFORD LN # NA
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3465
Practice Address - Country:US
Practice Address - Phone:970-874-8026
Practice Address - Fax:970-874-5043
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG88959Medicare ID - Type UnspecifiedMEDICARE