Healthcare Provider Details

I. General information

NPI: 1023281706
Provider Name (Legal Business Name): JERRY NOSANCHUK DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD SUITE 210
BINGHAM FARMS MI
48025-4367
US

IV. Provider business mailing address

4545 NORTHRIDGE CT
WEST BLOOMFIELD MI
48323-1397
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-7200
  • Fax: 248-644-7210
Mailing address:
  • Phone: 248-926-8080
  • Fax: 248-926-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY NOSANCHUK
Title or Position: PHYSICIAN
Credential: DO
Phone: 248-926-8080