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General NPI Number Information
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NPI Number | 1386140408
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Entity Type | Individual
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Provider Name | MICHAEL NELSON
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Gender | Male
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 2001 W 68TH ST STE 202
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City | HIALEAH
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State | FL
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Zip | 33016-1801
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Country | US
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Telephone | 305-364-2107
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Fax |
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Provider Business Mailing Address
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Address Line | 2154 NICE AVE
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City | MENTONE
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State | CA
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Zip | 92359-9659
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Country | US
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Telephone | 440-296-6412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | XXXX
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License Number State | FL
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