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General NPI Number Information
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NPI Number | 1780667436
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Entity Type | Organization
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Legal Business Name | NESTOR B. HALICKI D.O.,P,C.
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 5616 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1926
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Country | US
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Telephone | 248-674-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 5616 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1926
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Country | US
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Telephone | 248-674-2273
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NESTOR HALICKI
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Credential | D.O.
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Telephone | 248-674-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101009374
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5101009374
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License Number State | MI
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