Individual
DR. MARC SHELDON NUSHOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1101 MICHIGAN AVE, LOGANSPORT, IN 46947-1528
(574) 753-1302
Mailing address
1101 MICHIGAN AVE, LOGANSPORT, IN 46947-1528
(574) 753-1302
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02001520A
IN
207R00000X
Internal Medicine Physician
5101007102
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
02001520A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
5101007102
MI
207RP1001X
Pulmonary Disease Physician
02001520A
IN
207RP1001X
Pulmonary Disease Physician
5101007102
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000720342
ANTHEM BLUE CROSS
IN
05
—
200174470
—
IN
Enumeration date
02/28/2007
Last updated
11/02/2011
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