Provider Demographics
NPI:1871514323
Name:NELSON, MICHAEL R (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2301 HOUSE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3176
Mailing Address - Country:US
Mailing Address - Phone:307-634-5216
Mailing Address - Fax:307-638-6675
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-634-5216
Practice Address - Fax:307-638-6675
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY7294A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35030Medicare UPIN
WY20369Medicare ID - Type Unspecified