Provider Demographics
NPI:1235120569
Name:NESTOR, DUSHAN (MD)
Entity Type:Individual
Prefix:
First Name:DUSHAN
Middle Name:
Last Name:NESTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 E LONG LAKE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3793
Mailing Address - Country:US
Mailing Address - Phone:248-689-1330
Mailing Address - Fax:248-689-6424
Practice Address - Street 1:2888 E LONG LAKE RD
Practice Address - Street 2:STE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3793
Practice Address - Country:US
Practice Address - Phone:248-689-1330
Practice Address - Fax:248-689-6424
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044600207Q00000X
FLME 56924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B43500Medicare UPIN