Provider Demographics
NPI:1659364164
Name:NELSON, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11157
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-0157
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-346-7220
Practice Address - Fax:816-346-7242
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8N03207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19133017OtherBCBS KC MO
MO19133027OtherBCBS KC MO WOUND CARE
930016992OtherRR MEDICARE GROUP CD1534
MOP00604070OtherRR MEDICARE GROUP DN0988
MO19133027OtherBCBS MO WOUND CARE
MO202930913Medicaid
MO19133017OtherBCBS KC MO
930016992OtherRR MEDICARE GROUP CD1534
MOP00604070OtherRR MEDICARE GROUP DN0988