Individual
DR. RONALD D NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
610 N MICHIGAN ST, STE 400, SOUTH BEND, IN 46601-1081
(574) 647-8120
(574) 647-3111
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01031367A
IN
207RC0000X
Cardiovascular Disease Physician
01031367A
IN
207RI0011X
Interventional Cardiology Physician
Primary
01031367A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000849518
BCBS BMG ADVANCED CARDIO SPECIALIST
IN
05
—
100163560
—
IN
Enumeration date
07/07/2005
Last updated
04/28/2023
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