Healthcare Provider Details

I. General information

NPI: 1992790570
Provider Name (Legal Business Name): J MICHAEL NELSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH MICHAEL NELSON D.O.

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N10561 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

IV. Provider business mailing address

707 CONKLIN ST
TECUMSEH MI
49286-1011
US

V. Phone/Fax

Practice location:
  • Phone: 906-932-2525
  • Fax:
Mailing address:
  • Phone: 517-423-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101014291
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.008517
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: