Provider Demographics
NPI:1164846929
Name:NELLI MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:NELLI MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JINSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-299-9850
Mailing Address - Street 1:5827 CALGARY CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3070
Mailing Address - Country:US
Mailing Address - Phone:248-759-4852
Mailing Address - Fax:248-299-9860
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3150
Practice Address - Country:US
Practice Address - Phone:248-759-4852
Practice Address - Fax:248-299-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085938207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301085938OtherSTATE LICENSE
MI5315044008OtherCDS
MI5315044008OtherCDS