Provider Demographics
NPI:1548263429
Name:MOLESKI, MICHAEL DAMIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAMIAN
Last Name:MOLESKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22 N HUDSON ST
Mailing Address - Street 2:
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:517-278-2246
Practice Address - Fax:517-278-0426
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010336102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710073Medicaid
MI3001200061OtherBCBS
MI1710073Medicaid
MI3001200061OtherBCBS