Individual
DR. NICHOLAS MICHAEL KOLANKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 E MEDICAL CENTER DR, 2ND FLOOR TAUBMAN CENTER RECP A, ANN ARBOR, MI 48109-5326
(734) 936-5850
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
125052322
IL
2085R0202X
Diagnostic Radiology Physician
4301098589
MI
2085R0202X
Diagnostic Radiology Physician
50104-20
WI
2085R0202X
Diagnostic Radiology Physician
Primary
67438-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125052322
ILLINOIS LICENSE NUMBER, TEMPORARY PHYSICIAN LICENSE
IL
05
—
1427214857
—
WI
Enumeration date
08/05/2008
Last updated
02/01/2024
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