MEDICARE: CARIN L. NIELSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301078471	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080B410330	OTHER	MI	BCBS GROUP BILLING #
2	0802410252	OTHER	MI	BCBS PIN

General Provider Information

NPI Number	:	1184682924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIN L. NIELSEN M.D.

Provider Business Mailing Address
First Line	:	4727 LAKESHORE RD
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-9752
Country	:	US
Telephone Number	:	231-638-5585
Fax Number	:	231-577-9006

Provider Business Practice Location Address
First Line	:	4727 LAKESHORE RD
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-9752
Country	:	US
Telephone Number	:	231-638-5585
Fax Number	:	231-577-9006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	01/11/2024

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