Provider Demographics
NPI:1114914835
Name:NIDA, TODD Y (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:Y
Last Name:NIDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:248-784-3743
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-858-3812
Practice Address - Fax:248-858-3815
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-10-04
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Provider Licenses
StateLicense IDTaxonomies
MI4301066041207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG13799Medicare UPIN
MI0Q26462Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER