MEDICARE: DR. BRIAN NOLAN 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	174400000X	Specialist	4301038539	MI
2	208000000X	Pediatrics Physician	4301038539	MI
3	2080P0203X	Pediatric Critical Care Medicine Physician	4301038539	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992783534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN NOLAN MD

Provider Business Mailing Address
First Line	:	4465 WARWICK CIRCLE DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8337
Country	:	US
Telephone Number	:	810-233-7103
Fax Number	:	810-233-9710

Provider Business Practice Location Address
First Line	:	1 HURLEY PLZ
Second Line	:	SON, 5TH FLOOR
City	:	FLINT
State	:	MI
Zip	:	48503-5902
Country	:	US
Telephone Number	:	810-762-7283
Fax Number	:	810-257-9717

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	11/20/2017

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Directions to “ DR. BRIAN NOLAN MD” Practice Location

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