Healthcare Provider Details

I. General information

NPI: 1164846929
Provider Name (Legal Business Name): NELLI MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S ROCHESTER RD SUITE 115
ROCHESTER HILLS MI
48307-3150
US

IV. Provider business mailing address

5827 CALGARY CT
STERLING HEIGHTS MI
48314-3070
US

V. Phone/Fax

Practice location:
  • Phone: 248-759-4852
  • Fax: 248-299-9860
Mailing address:
  • Phone: 248-759-4852
  • Fax: 248-299-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301085938
License Number StateMI

VIII. Authorized Official

Name: DR. JINSON JOSE
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 248-299-9850