MEDICARE: NESTOR TOMYCZ M.D.

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	174400000X	Specialist	4301044274	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1006917	OTHER	MI	MCLAREN HEALTH PLAN
2	NT044274	OTHER	MI	BLUE CARE NETWORK
3	1006917	OTHER	MI	MCLAREN HEALTH ADVANTAGE
4	P00089687	OTHER	MI	PALMETTO GBA RAILROAD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	A74468	OTHER	MA	HEALTH ALLIANCE PLAN
7	NT044274	OTHER	MI	BLUE CROSS BLUE SHIELD
8	1102508011	OTHER	MI	HEALTH PLUS OF MICHIGAN

General Provider Information

NPI Number	:	1396850293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NESTOR TOMYCZ M.D.

Provider Business Mailing Address
First Line	:	5040 VILLA LINDE PKWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3445
Country	:	US
Telephone Number	:	810-230-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 VILLA LINDE PKWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3445
Country	:	US
Telephone Number	:	810-230-0788
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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Directions to “ NESTOR TOMYCZ M.D.” Practice Location

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