Individual
DR. MARK L NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
60 W BIG BEAVER RD, STE 120, BLOOMFIELD HILLS, MI 48304
(248) 540-9100
(248) 540-1223
Mailing address
60 W BIG BEAVER RD, STE 120, BLOOMFIELD HILLS, MI 48304
(248) 540-9100
(248) 540-1223
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301045147
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070002264
RAILROAD MEDICARE PIN
MI
01
—
0F34680
BCBSM TYPE 11
MI
Enumeration date
03/24/2006
Last updated
01/13/2014
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