MEDICARE: DR. MICHAEL E. NELLESTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202K00000X	Phlebology Physician	101630	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104848662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E. NELLESTEIN M.D.

Provider Business Mailing Address
First Line	:	1341 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2457
Country	:	US
Telephone Number	:	816-291-4149
Fax Number	:	816-897-3969

Provider Business Practice Location Address
First Line	:	1341 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2457
Country	:	US
Telephone Number	:	816-291-4149
Fax Number	:	816-897-3969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/29/2016

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