Provider Demographics
NPI:1245366376
Name:GADZINSKI, DAVID ZIGMUND (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ZIGMUND
Last Name:GADZINSKI
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 1:126 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:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080001032OtherRAILROAD MEDICARE
MI0E36001001OtherBC PPI
MI1443200Medicaid
MI0805300051OtherBC INDIVIDUAL
MI0E36001001OtherBC PPI
B45634Medicare UPIN
MI1443200Medicaid