Provider Demographics
NPI:1184682924
Name:NIELSEN, CARIN L (MD)
Entity Type:Individual
Prefix:
First Name:CARIN
Middle Name:L
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9752
Mailing Address - Country:US
Mailing Address - Phone:231-638-5585
Mailing Address - Fax:231-577-9006
Practice Address - Street 1:4727 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9752
Practice Address - Country:US
Practice Address - Phone:231-638-5585
Practice Address - Fax:231-577-9006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B410330OtherBCBS GROUP BILLING #
MI0802410252OtherBCBS PIN
MI4727931 10Medicaid
H99041Medicare UPIN
MI4727931 10Medicaid