Defauw, Nicholas

Defauw, Nicholas is an individual health care provider with primary practice located at 1824 Dorchester Ct Ste A , Goshen IN 46526. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Defauw, Nicholas can be contacted via phone (574) 534-2548.

Contact Information

Primary practice address
1824 Dorchester Ct Ste A Goshen IN 46526
Phone: (574) 534-2548
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 02005770A Indiana

Profile Details

NPI number 1578791398
LBN Legal business name Defauw, Nicholas
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 1st, 2009
Last updated Mar 18th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578791398 NPPES
Indiana MEDICAID 300029326

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