Healthcare Provider Details

I. General information

NPI: 1164436671
Provider Name (Legal Business Name): JAMES BARRY NOLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 WILD DR
RICHLAND MI
49083-9361
US

IV. Provider business mailing address

1805 WILD DR
RICHLAND MI
49083-9361
US

V. Phone/Fax

Practice location:
  • Phone: 269-203-6192
  • Fax:
Mailing address:
  • Phone: 269-203-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301046133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: