Provider Demographics
NPI:1467421495
Name:NELSON, TERRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:NELSON
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 1:315 TURWILL LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4231
Mailing Address - Country:US
Mailing Address - Phone:269-343-8170
Mailing Address - Fax:269-382-2388
Practice Address - Street 1:315 TURWILL LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4231
Practice Address - Country:US
Practice Address - Phone:269-343-8170
Practice Address - Fax:269-382-2388
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038754207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2864753Medicaid
MI1467421495Medicaid
B43163Medicare UPIN
MI2864753Medicaid
MIOC96076001Medicare PIN