Healthcare Provider Details

I. General information

NPI: 1851342349
Provider Name (Legal Business Name): BRIAN WILLIAM NIELSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE N1100
KALAMAZOO MI
49007
US

IV. Provider business mailing address

601 JOHN ST STE N1100
KALAMAZOO MI
49007-5349
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-7887
  • Fax:
Mailing address:
  • Phone: 269-341-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042.0012157
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number21228
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC2939
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301078174
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: