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General NPI Number Information
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NPI Number | 1932317450
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Entity Type | Organization
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Legal Business Name | ALLAN D. NELSON, M.D.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 500 HANCOCK ST
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City | PENTWATER
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State | MI
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Zip | 49449-0619
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Country | US
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Telephone | 231-869-7051
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Fax | 231-869-5536
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Provider Business Mailing Address
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Address Line | PO BOX 619 500 HANCOCK ST
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City | PENTWATER
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State | MI
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Zip | 49449-0619
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Country | US
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Telephone | 231-869-7051
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Fax | 231-869-5536
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALLAN D. NELSON
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Credential | M.D.
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Telephone | 231-869-7051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 4301036682
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License Number State | MI
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