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NPI Code Detail

MEDICARE: D NESTOR MD PC

MEDICARE: D NESTOR MD PC
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
1207Q00000XFamily Medicine Physician4301068171MI
2207Q00000XFamily Medicine Physician4301044600MI

General Provider Information

NPI Number : 1790898237
Entity Type Code : Organization
Provider Name (Legal Business Name) : D NESTOR MD PC
Provider Business Mailing Address
First Line : 2888 E LONG LAKE RD
Second Line : SUITE 105
City : TROY
State : MI
Zip : 48085-3700
Country : US
Telephone Number : 248-689-1330
Fax Number : 248-689-6424
Provider Business Practice Location Address
First Line : 2888 E LONG LAKE RD
Second Line : SUITE 105
City : TROY
State : MI
Zip : 48085-3700
Country : US
Telephone Number : 248-689-1330
Fax Number : 248-689-6424
Authorized Official
Title or Position : PRESIDENT
Name : DR. DUSHAN NESTOR
Credential : MD
Telephone Number : 248-689-1330
Provider Enumeration Date : 08/17/2006
Last Update Date : 07/25/2007

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