Individual
PHILIP T NELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2865 N REYNOLDS RD, SUITE 230, TOLEDO, OH 43615-2068
(419) 578-4367
(419) 537-5639
Mailing address
6591 W CENTRAL AVE, SUITE 202, TOLEDO, OH 43617-1087
(419) 517-6599
(419) 517-0503
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
35049048
OH
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
35049048
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0517668
—
OH
01
—
1804611061
BCBS OF MICHIGAN
MI
01
—
NE0531841
MEDICARE PTAN
OH
Enumeration date
06/01/2005
Last updated
04/05/2017
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