Provider Demographics
NPI:1174521082
Name:NIELSON, WILLIAM M (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:NIELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-0175
Mailing Address - Fax:859-441-3698
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:STE 302
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-371-4020
Practice Address - Fax:859-746-7464
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00165213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001654Medicaid
KY000000032629OtherANTHEM
KY4393890OtherAETNA
KY27-00334OtherUHC
KY90040080Medicaid
KYK122230Medicare PIN
KY2011102Medicare PIN
KY80001654Medicaid
KY4393890OtherAETNA
KYT53939Medicare UPIN
KY000000032629OtherANTHEM
KY0111Medicare PIN
KY6464Medicare PIN