Provider Demographics
NPI:1710944764
Name:NIELSON, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:NIELSON
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:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-0752
Mailing Address - Country:US
Mailing Address - Phone:660-463-1365
Mailing Address - Fax:660-463-1367
Practice Address - Street 1:3619 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3188
Practice Address - Country:US
Practice Address - Phone:816-254-7310
Practice Address - Fax:816-461-2367
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6157207R00000X
KS0414225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27663024OtherBCBS - KC
KS100446300AMedicaid
148565OtherCOVENTRY
MO203190020Medicaid
MOL69A793AMedicare Oscar/Certification
MO001013562Medicare Oscar/Certification
KS080193156Medicare Oscar/Certification
C50291Medicare UPIN
MO203190020Medicaid
MO080180656Medicare Oscar/Certification
MOL69A793Medicare Oscar/Certification
MO080180654Medicare Oscar/Certification