Individual
DR. JERRY LEON NOSANCHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
31500 TELEGRAPH RD, SUITE 210, BINGHAM FARMS, MI 48025-4367
(248) 644-7200
(248) 644-7210
Mailing address
4545 NORTHRIDGE CT, WEST BLOOMFIELD, MI 48323-1397
(248) 926-8080
(248) 926-8077
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
5101005933
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0158224424
BLUE CROSS BLUE SHIELD
MI
Enumeration date
01/03/2007
Last updated
01/26/2026
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