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General NPI Number Information
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NPI Number | 1477420479
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Entity Type | Organization
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Legal Business Name | KEVIN NOLAN MD PC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 22250 PROVIDENCE DR STE 608
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City | SOUTHFIELD
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State | MI
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Zip | 48075-6214
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Country | US
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Telephone | 248-849-6350
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Fax | --
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Provider Business Mailing Address
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Address Line | 7650 COOLEY LAKE RD PO BOX 43
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City | UNION LAKE
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State | MI
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Zip | 48387-9998
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Country | US
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Telephone | 248-231-8381
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Fax | --
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN NOLAN
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Credential | MD
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Telephone | 248-231-8381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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