Provider Demographics
NPI:1972600286
Name:NELSON, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 292
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-5700
Mailing Address - Fax:
Practice Address - Street 1:RIVERSIDE PROFESSIONAL BUILDING
Practice Address - Street 2:SECOND FLOOR, SUITE 200, 606 24TH AVENUE SOUTH
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN219582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16-00526OtherMEDICA CHOICE
MN156505OtherFAIRVIEW
IA0529255Medicaid
MN1023526OtherPREFERRED ONE
MN16-02032OtherMEDICA PRIMARY
MN75R76NEOtherBLUE CROSS BLUE SHIELD
MNHP11112OtherHEALTH PARTNERS
MT0052683Medicaid
MN117050OtherUCARE
MN447578000Medicaid
MN949395OtherARAZ