Healthcare Provider Details

I. General information

NPI: 1154385805
Provider Name (Legal Business Name): MICHAEL SCOTT NOSANOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MANSION ST STE 2D
MARSHALL MI
49068-1167
US

IV. Provider business mailing address

200 N MADISON ST
MARSHALL MI
49068-1143
US

V. Phone/Fax

Practice location:
  • Phone: 269-789-0015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMN053930
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01075631A
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: