DR. MARK RYAN NIKKEL (NPI# 1699762336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699762336 |
| Entity Type | Individual |
| Full Name | DR. MARK RYAN NIKKEL |
| Credential | DO |
| Practice Address |
955 S Bailey Ave South Haven MI 49090-6743 |
| Practice Telephone | 2696375271 |
| Practice Fax Number | 2696392818 |
| Mailing Telephone | 2696375271 |
| Mailing Fax Number | 2696392818 |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2020-10-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 36100980 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 31622992 | 01 |
| IL | GROUP NPI NUMBER | 1023138633 | 01 |
| IL | STATE LICENSE NUMBER | 036-100980 | 01 |
| IL | 036100980 | 05 |
| Street Address |
955 S BAILEY AVE |
| City | SOUTH HAVEN |
| State | MI |
| Zip Code | 49090-6743 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548256449 | William Dean Gilmer | Nurse Anesthetist, Certified Registered | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2005-09-26 |
| 1184245342 | Lynn Yvette Sharpe | Physical Therapist | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2020-04-29 |
| 1174142442 | Kim House | Dietitian, Registered | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2020-04-15 |
| 1447803366 | Josiah Griffore | Physical Therapist | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2019-07-19 |
| 1639730948 | Scott Eric Smith | Occupational Therapist | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2019-06-26 |
| 1083114532 | Sarah R Rucano | Specialist/Technologist | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2018-02-20 |
| 1356718761 | South Haven Community Health System | General Acute Care Hospital | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2015-09-01 |
| 1215312202 | Katrina Nichole Barrett | Nurse Practitioner | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2015-07-20 |
| 1841698917 | Christopher Wendling | Specialist/Technologist | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2014-12-05 |
| 1952742603 | Andrew Josiah Rife | Physician Assistant | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2013-07-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295234490 | Katara Therapy, LLC | Social Worker | 13560 76th Street, Suite 3, South Haven, MI 49090 | 2018-02-03 |
| 1487022091 | Kevin E. Ferrell | Physician Assistant | 955 S. Bailey Avenue, South Haven, MI 49090 | 2015-09-14 |
| 1942638002 | Birdie Farley | Chore Provider | 26725 M-140 Hwy, South Haven, MI 49090 | 2013-10-28 |
| 1730514910 | Rebecca A. Bennett | Counselor | 1675 Phoenix Road, Suite 9, South Haven, MI 49090 | 2013-09-06 |
| 1902149818 | Bronson South Haven Hospital | Emergency Medicine | 970 S Bailey Ave, South Haven, MI 49090 | 2013-03-28 |
| 1265629927 | Cecilia Liz Vives Vasquez | Physical Therapist | 23701 Red Arrow Hwy, Mattawan, MI 49090 | 2007-09-26 |
| 1518089788 | Donald Jam,es Buckley | Pharmacist | 955 S Bailey, South Haven, MI 49090 | 2007-04-06 |
| 1366568966 | Norman M Maly | Dentist | 05055 Blue Star Hwy, South Haven, MI 49090 | 2007-03-22 |
| 1639264062 | Deborah Sue Distefano | Pharmacy Technician | 512 Phoenix Street, South Haven, MI 49090 | 2006-10-03 |
| 1053357897 | Stephen Earl Tolen | Chiropractor | 325 Superior St., South Haven, MI 49090 | 2006-06-21 |
| Find all providers in zip 49090 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598998288 | Nicholas Loafman | Orthopaedic Surgery | 955 S Bailey Ave, South Haven, MI 49090-6743 | 2009-08-27 |
| 1669698668 | South Haven Orthopedics | Orthopaedic Surgery | 955 S Bailey Ave, South Haven, MI 49090-9701 | 2007-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740805365 | Conner D Ahlgren | Orthopaedic Surgery | 3535 W 13 Mile Rd Ste 742, Royal Oak, MI 48073-6770 | 2020-06-09 |
| 1063035319 | Alex Kane Miller | Orthopaedic Surgery | 3577 W 13 Mile Rd Ste 402, Royal Oak, MI 48073-6710 | 2020-05-21 |
| 1396374716 | Arjun Patel | Orthopaedic Surgery | Ascension Genesys, Gme Dept, One Genesys Pkwy, Grand Blanc, MI 48439-4843 | 2020-04-07 |
| 1346876711 | Timothy Curtis Mead | Orthopaedic Surgery | 4752 Lake Harbor Rd, Norton Shores, MI 49441-5236 | 2020-03-18 |
| 1932751112 | Mendelson Warren Pharmacy | Orthopaedic Surgery | 11900 E 12 Mile Rd Ste 105, Warren, MI 48093-3487 | 2019-07-09 |
| 1023678059 | Th Mg Ohio LLC | Orthopaedic Surgery | 1050 Wilshire Dr Ste 300, Troy, MI 48084-1526 | 2019-06-20 |
| 1609430321 | Mohamed Saad-waterworks, PC | Orthopaedic Surgery | 21031 Michigan Ave Fl 2, Dearborn, MI 48124-2339 | 2019-04-29 |
| 1346804135 | Matthew M Astolfi | Orthopaedic Surgery | 3601 W Thirteenth Mile Road, Royal Oak, MI 48073 | 2019-04-26 |
| 1588228845 | Muhammad Talha Padela | Orthopaedic Surgery | 3990 John R St Ste 7b, Detroit, MI 48201 | 2019-04-23 |
| 1134681125 | Neuro Spine Institute Pllc | Orthopaedic Surgery | 29255 Northwestern Hwy Ste 202, Southfield, MI 48034-5741 | 2019-04-01 |
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| City | SOUTH HAVEN |
| Zip Code | 49090 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.