Healthcare Provider Details

I. General information

NPI: 1992783534
Provider Name (Legal Business Name): BRIAN NOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ SON, 5TH FLOOR
FLINT MI
48503-5902
US

IV. Provider business mailing address

4465 WARWICK CIRCLE DR
GRAND BLANC MI
48439-8337
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-7283
  • Fax: 810-257-9717
Mailing address:
  • Phone: 810-233-7103
  • Fax: 810-233-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301038539
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301038539
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301038539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: