Provider Demographics
NPI:1992783534
Name:NOLAN, BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4465 WARWICK CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8337
Mailing Address - Country:US
Mailing Address - Phone:810-233-7103
Mailing Address - Fax:810-233-9710
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:SON, 5TH FLOOR
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-762-7283
Practice Address - Fax:810-257-9717
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038539174400000X, 208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3258589Medicaid
MI0P19180Medicare ID - Type Unspecified
MI3258589Medicaid