Provider Demographics
NPI:1982606109
Name:NELSEN, PHILIP T (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:T
Last Name:NELSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6591 W CENTRAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1087
Mailing Address - Country:US
Mailing Address - Phone:419-517-6599
Mailing Address - Fax:419-517-0503
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:SUITE 230
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-4367
Practice Address - Fax:419-537-5639
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
OH35049048207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNE0531841OtherMEDICARE PTAN
MI1804611061OtherBCBS OF MICHIGAN
OH0517668Medicaid
OHC49813Medicare UPIN
OH0517668Medicaid
OH0531841Medicare PIN