Provider Demographics
NPI:1790898237
Name:D NESTOR MD PC
Entity Type:Organization
Organization Name:D NESTOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-689-1330
Mailing Address - Street 1:2888 E LONG LAKE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3700
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:SUITE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3700
Practice Address - Country:US
Practice Address - Phone:248-689-1330
Practice Address - Fax:248-689-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044600207Q00000X
MI4301068171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M82170Medicare PIN