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General NPI Number Information
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NPI Number | 1528394731
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Entity Type | Organization
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Legal Business Name | THE TRAVELING MEDICINE MAN, PLLC
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 601 JOHN ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-341-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 198 S MAIN ST SUITE 3
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-7917
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Country | US
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Telephone | 586-465-2879
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Fax | 586-465-5424
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Authorized Official
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Title or Position | OWNER
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Name | MARC NUSHOLTZ
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Credential | DO
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Telephone | 260-312-6397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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