RICHARD K NICCUM MD
NPI 1417907122
Emergency Medicine in Fort Wayne, IN

Active since May 11, 2006
2121 LAKE AVE, FORT WAYNE, IN 46805(260) 426-5431 Get Directions Write a Review

NPPES record last updated: May 22, 2013. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Richard K Niccum Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RICHARD K NICCUM MD (NPI 1417907122) is an individual emergency medicine provider in Fort Wayne, Indiana, licensed in Indiana (01037769A) and active in the NPI registry since May 2006.

NPPES Registry Identity

NPI1417907122
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameRICHARD K NICCUMCredential: MD
Location Address2121 LAKE AVEFort Wayne, IN 46805-5100
Mailing Address3460 N State Road 109Columbia City, IN 46725-8953 · (260) 229-1714
Sole ProprietorYes
Enumeration DateMay 11, 2006
Last NPPES UpdateMay 22, 2013
NPI 1417907122 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License Licensed in IN · 01037769A
Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

2121 LAKE AVE, Fort Wayne, IN 46805

Other Identifiers 3

Medicare ID-Type Unspecified142930JJIN · Medicare
Medicare UPINE11156IN
Medicaid200210570IN

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Social Worker (Clinical)
2121 LAKE AVE
FORT WAYNE, IN 46805
Dentist (General Practice)
2121 LAKE AVE
FORT WAYNE, IN 46805
Social Worker (Clinical)
2121 LAKE AVE, VA-NIHCS
FT WAYNE, IN 46805
Physician Assistant
2121 LAKE AVE
FORT WAYNE, IN 46805
Audiologist
2121 LAKE AVE
FORT WAYNE, IN 46805
Social Worker (Clinical)
2121 LAKE AVE
FORT WAYNE, IN 46805
Surgery
2121 LAKE AVE, VETERANS AFFAIRS MEDICAL CENTER
FORT WAYNE, IN 46805
Internal Medicine (Cardiovascular Disease)
2121 LAKE AVE
FORT WAYNE, IN 46805

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1417907122, enumerated as an "individual" on May 11, 2006.

The provider is located at 2121 LAKE AVE FORT WAYNE, IN 46805 and the phone number is (260) 426-5431.

Emergency Medicine with taxonomy code 207P00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.