Provider Demographics
NPI:1962410472
Name:KANDULSKI, ADAM T (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:KANDULSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-753-5300
Mailing Address - Fax:989-753-5099
Practice Address - Street 1:1015 S WASHINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-753-5300
Practice Address - Fax:989-753-5099
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAK067829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0986021OtherHEALTH PLUS
MI0730789OtherBCBS OF MICHIGAN
MI0800910121OtherBLUE CROSS BLUE SHIELD
MI4524151Medicaid
MI4524151Medicaid
MI0730789OtherBCBS OF MICHIGAN