Healthcare Provider Details

I. General information

NPI: 1871989962
Provider Name (Legal Business Name): FELIX NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 OVID HEALTH CARE
OVIDE MI
48866
US

IV. Provider business mailing address

629 W HOLBROOK AVE
FLINT MI
48505-2057
US

V. Phone/Fax

Practice location:
  • Phone: 866-486-8811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number145007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: