Provider Demographics
NPI:1073844841
Name:EDWARD J NEBEL, M.D. PC
Entity Type:Organization
Organization Name:EDWARD J NEBEL, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-982-9911
Mailing Address - Street 1:2615 ELECTRIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6575
Mailing Address - Country:US
Mailing Address - Phone:810-982-9911
Mailing Address - Fax:810-985-7740
Practice Address - Street 1:2615 ELECTRIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6575
Practice Address - Country:US
Practice Address - Phone:810-982-9911
Practice Address - Fax:810-985-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEN027615207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0741076OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI2887650Medicaid
MI0741076OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI2887650Medicaid