Provider Demographics
NPI:1447240676
Name:NAKAGAWA, NOBUO (MD)
Entity Type:Individual
Prefix:
First Name:NOBUO
Middle Name:
Last Name:NAKAGAWA
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 1:3400 N CENTER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7919
Mailing Address - Country:US
Mailing Address - Phone:989-753-9000
Mailing Address - Fax:989-753-4024
Practice Address - Street 1:3400 N CENTER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7919
Practice Address - Country:US
Practice Address - Phone:989-753-9000
Practice Address - Fax:989-753-4024
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010954342085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200340900Medicaid
MIE29187OtherMEDICARE UPIN
MI160160ROtherMEDICARE PIN