Provider Demographics
NPI:1861438996
Name:KING, NICHOLAS LANSING (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LANSING
Last Name:KING
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 90379
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-0379
Mailing Address - Country:US
Mailing Address - Phone:317-257-5886
Mailing Address - Fax:
Practice Address - Street 1:10150 LANTERN RD
Practice Address - Street 2:SUITE 175
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9706
Practice Address - Country:US
Practice Address - Phone:317-257-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059394A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200824130Medicaid
IN200824130Medicaid