Provider Demographics
NPI:1053601195
Name:MOLLBERG, NATHAN MANDEL (DO)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MANDEL
Last Name:MOLLBERG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-460
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7333
Mailing Address - Fax:269-341-7371
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-460
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7333
Practice Address - Fax:269-341-7371
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2022-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125.051876208600000X
MI5101021356208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery