Healthcare Provider Details

I. General information

NPI: 1245767896
Provider Name (Legal Business Name): ADRIAN NAHIRNYJ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MEDICAL CAMPUS DR
TRAVERSE CITY MI
49684-7823
US

IV. Provider business mailing address

400 HOBART ST
CADILLAC MI
49601-2331
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-8000
  • Fax: 231-935-8099
Mailing address:
  • Phone: 231-876-7807
  • Fax: 231-876-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101023134
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: