Provider Demographics
NPI:1053383919
Name:NYKAMP, LOUIS J (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:NYKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-455-5000
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1698
Practice Address - Country:US
Practice Address - Phone:616-741-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN447892084P0800X
MI43010886832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN746150000Medicaid
H66779Medicare UPIN
MN260002102Medicare ID - Type Unspecified
MN260050637Medicare ID - Type UnspecifiedRAILROAD
MID16083114Medicare PIN