| Mr Ryan David Nicklas, MD | |
|
4881 Sugar Maple Dr, Wpafb, OH 45433-5529 | |
| (376) 302-1619 | |
| Not Available |
| Full Name | Mr Ryan David Nicklas |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology |
| Location | 4881 Sugar Maple Dr, Wpafb, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770075533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | MD476020 (Pennsylvania) | Secondary |
| 207L00000X | Anesthesiology | 010050 (Georgia) | Secondary |
| 207L00000X | Anesthesiology | 35.149304 (Ohio) | Primary |
| Entity Name | Anesthesiology Services Network Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1821076779 PECOS PAC ID: 8820902794 Enrollment ID: O20031114000467 |
| Entity Name | Kettering Independent Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1629387865 PECOS PAC ID: 3173710936 Enrollment ID: O20101207000425 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Ryan David Nicklas, MD 4881 Sugar Maple Dr, Wpafb, OH 45433-5529 Ph: (937) 630-2161 | Mr Ryan David Nicklas, MD 4881 Sugar Maple Dr, Wpafb, OH 45433-5529 Ph: (376) 302-1619 |
Geoffrey Thomas, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 4881 Sugar Maple Dr, Wpafb, OH 45433 Phone: 937-257-3098 | |
Dr. Stefani Lorane Diedrich, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 4881 Sugar Maple Dr, Wpafb, OH 45433 Phone: 937-630-2161 | |
Dr. Taylor R. Kjar, DO Anesthesiology Medicare: Medicare Enrolled Practice Location: 88th Medical Group, 4881 Sugar Maple Dr, Wpafb, OH 45433 Phone: 937-257-0837 |