Individual
MARK E NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 751-2649
(765) 281-6671
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01067783A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
01067783A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300030750
—
IN
01
—
Q00370660
RAILROAD PTAN
IN
Enumeration date
07/02/2007
Last updated
12/04/2024
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