Healthcare Provider Details

I. General information

NPI: 1144280694
Provider Name (Legal Business Name): COLDWATER RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 E CHICAGO ST
COLDWATER MI
49036-2041
US

IV. Provider business mailing address

22 N HUDSON ST PO BOX 489
COLDWATER MI
49036-1610
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-5400
  • Fax:
Mailing address:
  • Phone: 517-278-2246
  • Fax: 517-278-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMM033610
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL DAMIAN MOLESKI
Title or Position: RADIOLOGIST
Credential: MD
Phone: 517-278-2246