Individual
MARK ALBERT NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 I ST FL 2, LA PORTE, IN 46350-5533
(219) 872-6566
(219) 872-2712
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01040264A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100209820A
—
IN
Enumeration date
06/12/2006
Last updated
10/13/2023
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