Basic Information
| Provider Information | |||||||||
| NPI: | 1962683581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN SICKELS | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1631 ELYSIAN FIELDS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701178208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048212601 | ||||||||
| FaxNumber: | 5048146047 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 BEAUMONT CENTRE CIR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405131959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235544 | ||||||||
| FaxNumber: | 8592579286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD.201407 | LA | N | Other Service Providers | Specialist | 207R00000X | MD.201407 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | MD.201407 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 56921 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 1215597 | 05 | LA | MEDICAID |