Provider Demographics
NPI:1982641098
Name:NADOLSKI, DAVID LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEONARD
Last Name:NADOLSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6839
Mailing Address - Country:US
Mailing Address - Phone:989-832-6400
Mailing Address - Fax:989-832-3663
Practice Address - Street 1:5912 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6839
Practice Address - Country:US
Practice Address - Phone:989-832-6400
Practice Address - Fax:989-832-3663
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0988691OtherHEALTH PLUS
110042864OtherPALMETTO GBA
110125037OtherPALMETTO GBA - NB
MI1105610371OtherBLUE CROSS
MI1105610371OtherBLUE CARE NETWORK
611920000OtherUS DOL - NB
MI1483761Medicaid
602960800OtherU S DOL - MIMA
01002151OtherHEALTH PLUS
MI110E610541OtherBLUE CARE NETWORK
MI3254131Medicaid
MI0P50480001Medicare PIN
01002151OtherHEALTH PLUS
0988691OtherHEALTH PLUS
MI110E610541OtherBLUE CARE NETWORK