Organization Active NPI

Michael R Nicholson MD PLLC

  • Obstetrics & Gynecology Physician
  • Waterford, MI
National Provider Identifier
1295881373
Registry record updated Feb 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MICHAEL R NICHOLSON MD PLLC
Practice address
5220 Highland Rd
Suite 230
Waterford, MI 48327-1975
Phone
(248) 456-8001
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael R Nicholson, MD
Title
Owner
Phone
(248) 456-8001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X MI Primary

Addresses

Primary practice location

5220 Highland Rd
Suite 230
Waterford, MI 48327-1975

Mailing address

PO Box 1481
Clarkston, MI 48347-1481
Phone (248) 456-8001

Other identifiers 1

IdentifierTypeStateIssuer
4973416MedicaidMI

National Provider Directory

National Provider Directory

Locations

1750 S Telegraph Rd
Ste 108
Bloomfield Hills, MI 48302
Phone (248) 334-4505

1750 S Telegraph Rd
Ste 104
Bloomfield Hills, MI 48302
Phone (248) 256-5209

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423008000000",
    "number": "1295881373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1481",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483471481",
            "telephone_number": "248-456-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 HIGHLAND RD",
            "address_2": "SUITE 230",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271975",
            "telephone_number": "248-456-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R NICHOLSON MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2015-02-04",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-456-8001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4973416",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.