Individual
MARK A NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8901 W LINCOLN AVE, WEST ALLIS, WI 53227-2409
(414) 328-6000
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
24587-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32827100
—
WI
Enumeration date
02/20/2007
Last updated
07/09/2007
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