Philip Nelson

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Practice address

6124 N Overhill Ave
Chicago, IL 60631-3817

Phone

(773) 763-8202

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083768113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6124 N OVERHILL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313817",
            "telephone_number": "773-763-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6124 N OVERHILL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313817",
            "telephone_number": "773-763-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "PHILIP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Gene Nelson, PT
• Nicole Elizabeth Nelson, OTR/L
• Nikki Nelson, LCSW
• Noah Fielden Nelson, LCSW
• Noah Lynn Nelson, MD
• Princess Andriana Nelson
• Rebecca Lynne Nelson, A.M., L.C.S.W.
• Richard Lawrence Nelson, M.D.
• Ruth Nelson
• Scott A. Nelson

• Public Health Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• Public Health Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.