Provider Demographics
NPI:1154995660
Name:NESSEL, TREVOR ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ALEXANDER
Last Name:NESSEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E 9 MILE RD APT 420
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-3027
Mailing Address - Country:US
Mailing Address - Phone:248-504-1279
Mailing Address - Fax:
Practice Address - Street 1:28333 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1687
Practice Address - Country:US
Practice Address - Phone:248-504-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101027565207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology