Provider Demographics
NPI:1922056894
Name:NIELSEN, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:NIELSEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4630 SINGING HILLS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9702
Mailing Address - Country:US
Mailing Address - Phone:712-271-8346
Mailing Address - Fax:712-271-8347
Practice Address - Street 1:4630 SINGING HILLS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9702
Practice Address - Country:US
Practice Address - Phone:712-271-8346
Practice Address - Fax:712-271-8347
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2009-12-07
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Provider Licenses
StateLicense IDTaxonomies
IA036115004208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
D28654Medicare UPIN