Healthcare Provider Details

I. General information

NPI: 1083652135
Provider Name (Legal Business Name): DAVID L. NADOLSKI MD P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 EASTMAN AVE
MIDLAND MI
48640-6839
US

IV. Provider business mailing address

5912 EASTMAN AVE
MIDLAND MI
48640-6839
US

V. Phone/Fax

Practice location:
  • Phone: 989-832-6400
  • Fax: 989-832-3663
Mailing address:
  • Phone: 989-832-6400
  • Fax: 989-832-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number26785
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID LEONARD NADOLSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-832-6400