MEDICARE: DR. MICHAEL WARREN NIELSEN MD

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	207P00000X	Emergency Medicine Physician	A79412	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255301370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WARREN NIELSEN MD

Provider Business Mailing Address
First Line	:	3603 INGRAHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-6717
Country	:	US
Telephone Number	:	858-353-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-6236
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	02/04/2010

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