Provider Demographics
NPI:1134114184
Name:AXELSEN, NILS K (MD)
Entity Type:Individual
Prefix:
First Name:NILS
Middle Name:K
Last Name:AXELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S ENTERPRIZE PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-4118
Mailing Address - Country:US
Mailing Address - Phone:361-939-6510
Mailing Address - Fax:
Practice Address - Street 1:205 S ENTERPRIZE PKWY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-4118
Practice Address - Country:US
Practice Address - Phone:361-939-6510
Practice Address - Fax:580-357-1256
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100143950AMedicaid