Provider Demographics
NPI:1538137021
Name:TRUCCONE, NESTOR J (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:J
Last Name:TRUCCONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:43380 WOODWARD AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5050
Mailing Address - Country:US
Mailing Address - Phone:248-335-8500
Mailing Address - Fax:248-335-5430
Practice Address - Street 1:43380 WOODWARD AVE
Practice Address - Street 2:STE 105
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5050
Practice Address - Country:US
Practice Address - Phone:248-335-8500
Practice Address - Fax:248-335-5430
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010353452080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2102476Medicaid
MI2102476Medicaid
B46514Medicare UPIN