Provider Demographics
NPI:1043273048
Name:NELSON, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6622
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:800 E ELLIS RD
Practice Address - Street 2:SUITE 225
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5622
Practice Address - Country:US
Practice Address - Phone:231-798-9840
Practice Address - Fax:231-798-9740
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43272OtherPRIORITY HEALTH
MI4847214Medicaid
MIWN039918OtherBLUE CROSS BLUE SHIELD
MIWN039918OtherBLUE CROSS BLUE SHIELD
MIB43272Medicare UPIN