Individual
TODD A NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220-3712
(920) 320-2011
Mailing address
PO BOX 2290, MANITOWOC, WI 54221-2290
(920) 320-2591
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
44295
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207P00000X
—
WI
01
—
P00163398
RR MEDICARE
WI
Enumeration date
08/17/2006
Last updated
02/03/2012
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