Provider Demographics
NPI:1174650402
Name:LOIS A. NELSON, MD LLC
Entity Type:Organization
Organization Name:LOIS A. NELSON, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-536-1322
Mailing Address - Street 1:3454 OAK ALLEY CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1370
Mailing Address - Country:US
Mailing Address - Phone:419-536-1322
Mailing Address - Fax:419-536-0302
Practice Address - Street 1:3454 OAK ALLEY CT
Practice Address - Street 2:SUITE 202
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1370
Practice Address - Country:US
Practice Address - Phone:419-536-1322
Practice Address - Fax:419-536-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045307207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435130Medicaid
LO9348101Medicare PIN
9348104Medicare PIN
OH0435130Medicaid
9348103Medicare PIN
OH0435130Medicaid