JACK LEE NETTLETON M.D. NPI 1174523575

NPI Information

  • NPI: 1174523575
  • Provider Name: JACK LEE NETTLETON, M.D.
  • Classification: Radiology - 2085R0001X
  • Specialization: Radiation Oncology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4100 BEECHER RD
    SUITE A
    FLINT, MI
    ZIP 48532
  • Phone: (810) 342-3800

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NPI Details

Jack Lee Nettleton, M.D. is a radiation oncology radiology in Flint, MI. The provider is a radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. Jack Lee Nettleton, M.D. NPI is 1174523575. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4100 BEECHER RD
SUITE A
FLINT, MI
ZIP 48532-661
Phone: (810) 342-3800
Fax: (810) 342-3784

The NPI 1174523575 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/28/2005 and was last updated on 10/6/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0001XRadiologyRadiation OncologyJN047780MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1D42501MEDICARE UPIN
2OM87280002MEDICARE UPIN
34128490MEDICARE ID-TYPE UNSPECIFIEDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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