| Doctor Name: | MIKE NICHOLS |
| NPI Number: | 1285896373 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G49792 |
| Business Practice Address: | 14583 Big Basin Way #2b Saratoga, CA - 950706072 |
| Business Phone Number: | 4086472130 |
| Business Fax Number: | 8883626713 |
| Mailing Address: | 14583 Big Basin Way, #2b SARATOGA |
| State: | CA |
| Postal Code: | 950706072 |
| Phone Number: | 4086472130 |
| Fax Number: | 8883626713 |
| NPI Enumeration Date: | 06/30/2008 |
| NPI Last Update Date: | 05/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G49792 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |