Provider Demographics
NPI:1013216068
Name:GADZINSKI-WORDSWORTH, NICHOLAS MARTIN (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MARTIN
Last Name:GADZINSKI-WORDSWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6327
Mailing Address - Country:US
Mailing Address - Phone:586-263-3400
Mailing Address - Fax:586-412-3670
Practice Address - Street 1:15400 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-263-3400
Practice Address - Fax:586-412-3670
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine