Basic Information
| Provider Information | |||||||||
| NPI: | 1528094588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLAS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100-15TH AVE. | ||||||||
| Address2: | STE 180 | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147685430 | ||||||||
| FaxNumber: | 4147624225 | ||||||||
| Practice Location | |||||||||
| Address1: | 4448 W. LOOMIS RD. | ||||||||
| Address2: | STE 100 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532204851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142815150 | ||||||||
| FaxNumber: | 4142815767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 49329-020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.