Healthcare Provider Details

I. General information

NPI: 1952725178
Provider Name (Legal Business Name): STEVE MICHAEL NELSON M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 RIDGE LAKE BLVD BLDG STE 315
MEMPHIS TN
38120-9401
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD BLDG STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 877-348-1281
  • Fax: 901-227-3206
Mailing address:
  • Phone: 877-348-1281
  • Fax: 901-227-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number28908
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number27444
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number18138
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS0343
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: