JACK LEE NETTLETON (NPI# 1174523575) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174523575 |
| Entity Type | Individual |
| Full Name | JACK LEE NETTLETON |
| Credential | M.D. |
| Practice Address |
4100 Beecher Rd Suite A Flint MI 48532-3661 |
| Mailing Address |
Po Box 1236 Grand Blanc MI 48480-3236 |
| Practice Telephone | 8103423800 |
| Practice Fax Number | 8103423784 |
| Mailing Telephone | 8103423800 |
| Mailing Fax Number | 8103423784 |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2009-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
JN047780 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
4100 BEECHER RD SUITE A |
| City | FLINT |
| State | MI |
| Zip Code | 48532-3661 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659850162 | Angela Marie Hanna | Nurse Practitioner | 4100 Beecher Rd, Flint, MI 48532-3661 | 2018-08-07 |
| 1902305295 | Jennifer Lynn Chandler | Nurse Practitioner | 4100 Beecher Rd, Flint, MI 48532-3661 | 2018-02-02 |
| 1790952059 | Kiran Devisetty | Radiology | 4100 Beecher Rd, Suite A, Flint, MI 48532-3661 | 2008-05-14 |
| 1144403205 | Erin Jessica Burke | Physician Assistant | 4100 Beecher Rd, Suite A, Flint, MI 48532-3605 | 2007-12-12 |
| 1932315124 | Sandeep S Grewal | Internal Medicine | 4100 Beecher Rd, Ste B, Flint, MI 48532-3661 | 2007-05-15 |
| 1093839060 | Hesham E Gayar, M.d., P.C. | Radiology | 4100 Beecher Rd, Suite A, Flint, MI 48532-3605 | 2007-03-16 |
| 1316972086 | Christian Hyde | Radiology | 4100 Beecher Rd, Flint, MI 48532-3661 | 2006-07-11 |
| 1538105564 | Singh & Arora Oncology Hematology P C | Internal Medicine | 4100 Beecher Rd, Ste B, Flint, MI 48532-3605 | 2006-06-20 |
| 1700823705 | David Stuart Eilender | Internal Medicine | 4100 Beecher Rd, Ste. B, Flint, MI 48532-3661 | 2006-05-31 |
| 1396790986 | Dennis Lee Wallace | Physician Assistant | 4100 Beecher Rd, Suite A, Flint, MI 48532-3661 | 2006-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524859 | Amber Marie Lee | Physician Assistant | 2265 South Lindenroad, Suite A, Flint, MI 48532 | 2020-09-25 |
| 1639709496 | Tammara Kamei | Counselor | 2425 S.linden Rd, Suite D Unit 100, Flint, MI 48532 | 2020-01-21 |
| 1306481882 | Christine Rice | Case Manager/Care Coordinator | 3169 Beecher Road, Flint, MI 48532 | 2019-11-08 |
| 1780154336 | Sarah Marie Shaw | Case Manager/Care Coordinator | 2091 Professional Drive, Flint, MI 48532 | 2018-11-27 |
| 1215412093 | Adria D Haynes | Social Worker | G-4413 Corunna Rd., Flint, MI 48532 | 2018-09-27 |
| 1689159378 | Vip Smiles Dentistry, Pllc | Dentist | 1104 South Linden Rd, Building B, Suite 1, Flint, MI 48532 | 2018-09-27 |
| 1942794797 | Premier Eye Specialists Pllc | Ophthalmology | 1160 S Linden Rd, Bldg. 1 Ste. A, Flint, MI 48532 | 2018-06-15 |
| 1720587710 | Cassandra Socia | Dental Hygienist | G3222 Beecher Road, Flint, MI 48532 | 2018-02-06 |
| 1235660291 | Ashley L Boltjes | Massage Therapist | 3277 Beecher Rd, Flint, MI 48532 | 2017-03-22 |
| 1497202774 | Tyneshia Mcfarland | Home Health | 2104 Ridgecliffe Dr, Flint, MI 48532 | 2016-09-05 |
| Find all providers in zip 48532 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083903256 | Omar Hesham Gayar | Radiology | 4100 Beecher Rd Ste A, Flint, MI 48532-3661 | 2011-03-28 |
| 1467801985 | Collaborative Radiation Oncology Pllc | Radiology | 302 Kensington Ave, Flint, MI 48503-2044 | 2016-06-06 |
| 1104161363 | Dong Whan Oh Md Pllc | Radiology | 302 Kensington Ave, Flint, MI 48503-2044 | 2012-11-29 |
| 1124362272 | Haesook S Kim Md Pllc | Radiology | 302 Kensington Ave, Flint, MI 48503-2044 | 2012-11-15 |
| 1790952059 | Kiran Devisetty | Radiology | 4100 Beecher Rd, Suite A, Flint, MI 48532-3661 | 2008-05-14 |
| 1093839060 | Hesham E Gayar, M.d., P.C. | Radiology | 4100 Beecher Rd, Suite A, Flint, MI 48532-3605 | 2007-03-16 |
| 1497864680 | Flint Radiation Therapy | Radiology | 302 Kensington Ave, Flint, MI 48503-2044 | 2006-08-30 |
| 1316972086 | Christian Hyde | Radiology | 4100 Beecher Rd, Flint, MI 48532-3661 | 2006-07-11 |
| 1548298375 | Paul Kocheril | Radiology | 302 Kensington Ave, Flint, MI 48503-2044 | 2006-06-29 |
| 1245286731 | Genesys Hurley Cancer Institute | Radiology | 302 Kensington Ave, Flint, MI 48503 | 2006-05-26 |
| Find all providers in FLINT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.