Individual
RYAN JAMES NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11051 HALL RD STE 200, UTICA, MI 48317-5742
(586) 254-5759
(586) 254-5793
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
(586) 771-6620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5101018425
MI
208800000X
Urology Physician
Primary
5101018424
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06273
BCBSM
MI
Enumeration date
07/15/2009
Last updated
04/28/2021
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