Healthcare Provider Details

I. General information

NPI: 1780979658
Provider Name (Legal Business Name): SPENCER NADOLSKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E 8TH ST # 5134
HOLLAND MI
49423-3751
US

IV. Provider business mailing address

430 E 8TH ST # 5134
HOLLAND MI
49423-3751
US

V. Phone/Fax

Practice location:
  • Phone: 415-625-1768
  • Fax: 855-259-7555
Mailing address:
  • Phone: 415-625-1768
  • Fax: 855-259-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116023930
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberH0079510
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: