Individual
DR. RICHARD L NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 20, FORT WAYNE, IN 46845-1733
(260) 425-6940
(260) 425-6949
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01025422A
IN
208M00000X
Hospitalist Physician
01025422A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000655794
ANTHEM
IN
05
—
100360270
—
IN
01
—
P00836701
R.R. MEDICARE
IN
Enumeration date
01/08/2010
Last updated
10/20/2022
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