Provider Demographics
NPI:1629076328
Name:NELSON, RONALD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N MICHIGAN ST
Practice Address - Street 2:STE 400
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1081
Practice Address - Country:US
Practice Address - Phone:574-647-8120
Practice Address - Fax:574-647-3111
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031367A207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000849518OtherBCBS BMG ADVANCED CARDIO SPECIALIST
IN100163560Medicaid
IN000000333829OtherBCBS MEMORIAL
IN100163560Medicaid
IN100163560AMedicaid
IN000000333829OtherBCBS MEMORIAL
IN941030KMedicare PIN