MEDICARE: NICHOLAS MICHAEL CARDUCCI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301506160	MI
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	4301506160	MI

General Provider Information

NPI Number	:	1023514486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MICHAEL CARDUCCI MD

Provider Business Mailing Address
First Line	:	2305 GENOA BUSINESS PARK DR STE 250
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7006
Country	:	US
Telephone Number	:	810-494-2020
Fax Number	:	810-494-0127

Provider Business Practice Location Address
First Line	:	2305 GENOA BUSINESS PARK DR STE 250
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7006
Country	:	US
Telephone Number	:	810-494-2020
Fax Number	:	810-494-0127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	11/06/2025

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