Healthcare Provider Details

I. General information

NPI: 1023514486
Provider Name (Legal Business Name): NICHOLAS MICHAEL CARDUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 GENOA BUSINESS PARK DR STE 250
BRIGHTON MI
48114-7006
US

IV. Provider business mailing address

2305 GENOA BUSINESS PARK DR STE 250
BRIGHTON MI
48114-7006
US

V. Phone/Fax

Practice location:
  • Phone: 810-494-2020
  • Fax: 810-494-0127
Mailing address:
  • Phone: 810-494-2020
  • Fax: 810-494-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number4301506160
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301506160
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: