Individual
MICHAEL I MCNELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2730
(360) 414-2739
Mailing address
PO BOX 249, LONGVIEW, WA 98632-7154
(360) 414-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00031478
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00031478
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD00031478
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115014
LABOR & IND.
WA
05
—
150450
—
OR
01
—
290010407
RR MEDICARE
—
05
—
8207748
—
WA
01
—
8931504
CRIME VICTIMS
WA
Enumeration date
08/19/2005
Last updated
06/09/2010
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