Provider Demographics
NPI:1861503658
Name:DAVID Z GADZINSKI MD PC
Entity Type:Organization
Organization Name:DAVID Z GADZINSKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ZIGMUND
Authorized Official - Last Name:GADZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-845-1215
Mailing Address - Street 1:126 W LUDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2022
Mailing Address - Country:US
Mailing Address - Phone:231-845-1215
Mailing Address - Fax:
Practice Address - Street 1:126 W LUDINGTON AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2022
Practice Address - Country:US
Practice Address - Phone:231-845-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E360010OtherMI BLUE CROSS BLUE SHIELD
MI115533OtherPPOM
5972242OtherAETNA
MI1443200Medicaid
MI900019846OtherPRIORITY HEALTH
DG5084OtherRAILROAD MEDICARE
0E36001Medicare ID - Type Unspecified