1972600286 NPI number — MICHAEL T NELSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972600286 NPI number — MICHAEL T NELSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NELSON

Provider First Name:

MICHAEL

Provider Middle Name:

T

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1972600286

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Second Line Business Mailing Address:

420 DELAWARE STREET SE, MMC 292

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-273-5700

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

RIVERSIDE PROFESSIONAL BUILDING

Provider Second Line Business Practice Location Address:

SECOND FLOOR, SUITE 200, 606 24TH AVENUE SOUTH

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55454

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-273-5700

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  21958 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 16-00526 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 156505 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0529255 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1023526 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 16-02032 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 75R76NE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP11112 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0052683 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 117050 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 447578000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 949395 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".