Individual
JOHN M NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1253 N ALPINE RD, ROCKFORD, IL 61107
(779) 696-9201
Mailing address
PO BOX 7866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004542
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004542
—
IL
Enumeration date
10/11/2006
Last updated
02/19/2021
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