Provider Demographics
NPI:1144280694
Name:COLDWATER RADIOLOGY PC
Entity type:Organization
Organization Name:COLDWATER RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:MOLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-278-2246
Mailing Address - Street 1:22 N HUDSON ST
Mailing Address - Street 2:PO BOX 489
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1610
Mailing Address - Country:US
Mailing Address - Phone:517-278-2246
Mailing Address - Fax:517-278-0426
Practice Address - Street 1:274 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2041
Practice Address - Country:US
Practice Address - Phone:517-279-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM0336102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710073Medicaid
MI2956283Medicaid
MI0120006Medicare ID - Type UnspecifiedRADIOLOGIST MD
MI2956283Medicaid
MI1710073Medicaid
MI0123745Medicare ID - Type UnspecifiedRADIOLOGIST MD