Provider Demographics
NPI:1245291061
Name:NELSON, JAMES B (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3310
Mailing Address - Fax:414-805-3885
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3310
Practice Address - Fax:414-805-3885
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37286207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN697658100Medicaid
WI1245291061Medicaid
MN100000730OtherLAKEVIEW MEDICARE
MNC85725Medicare UPIN
MN100000730OtherLAKEVIEW MEDICARE
MN100000585Medicare PIN