Individual provider · Type 1 NPI

Benjamin Anthony Nicotera, MD

Student in an Organized Health Care Education/Training Program · O Fallon, IL

NPI number 1407353790 Active

Practice location

3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284

Call (618) 233-5480 Map

Fax (618) 222-4792

Mailing address

395 State St, Right Side
Amherst, MA 01002

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1407353790

Benjamin Anthony Nicotera, MD's National Provider Identifier is 1407353790, issued on Apr 12, 2018. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in O Fallon, IL. The record was last updated on Apr 12, 2018.