Provider Demographics
NPI:1902825714
Name:NIKSCH, WILLIAM LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LOUIS
Last Name:NIKSCH
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 1:1890 S US HIGHWAY 131
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8344
Mailing Address - Country:US
Mailing Address - Phone:231-487-2000
Mailing Address - Fax:
Practice Address - Street 1:1890 S US HIGHWAY 131
Practice Address - Street 2:SUITE 4
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8344
Practice Address - Country:US
Practice Address - Phone:231-487-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWN069686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIWN069686OtherSTATE LICENSE
MID95566Medicare UPIN