Organization
MARK L. NELSON, MD, PHD, PC
Active
Other names
AAA American Dermatology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LEE NELSON MD PHD (PRESIDENT)
(248) 540-9100
Entity
Organization
Contact information
Practice address
60 W BIG BEAVER RD, BLOOMFIELD HILLS, MI 48304-3909
(248) 540-9100
(248) 540-1223
Mailing address
60 W BIG BEAVER RD, BLOOMFIELD HILLS, MI 48304-3909
(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
MI
01
—
0706336300
BCBS MI
MI
01
—
0F34680
BCBSM TYPE 11
MI
Enumeration date
03/20/2008
Last updated
08/24/2009
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