Individual
GREGORY JOHN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
36500 AURORA DR, STE 430, SUMMIT, WI 53066-4899
(414) 454-6779
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9509
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002003754
—
NV
05
—
00G857910
—
CA
05
—
100180514
—
WI
05
—
XPY193917
—
CA
Enumeration date
07/18/2005
Last updated
09/24/2024
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