Provider Demographics
NPI:1396850293
Name:TOMYCZ, NESTOR (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:TOMYCZ
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 1:5040 VILLA LINDE PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3445
Mailing Address - Country:US
Mailing Address - Phone:810-230-0788
Mailing Address - Fax:
Practice Address - Street 1:5040 VILLA LINDE PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3445
Practice Address - Country:US
Practice Address - Phone:810-230-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1006917OtherMCLAREN HEALTH PLAN
MINT044274OtherBLUE CARE NETWORK
MI1006917OtherMCLAREN HEALTH ADVANTAGE
MIP00089687OtherPALMETTO GBA RAILROAD
MI104852985Medicaid
MAA74468OtherHEALTH ALLIANCE PLAN
MINT044274OtherBLUE CROSS BLUE SHIELD
MI1102508011OtherHEALTH PLUS OF MICHIGAN