Provider Demographics
NPI:1285194332
Name:NIELSEN, ALEXANDER WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:WILLIAM
Last Name:NIELSEN
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:P.O. BOX 26099
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2257
Mailing Address - Country:US
Mailing Address - Phone:414-805-3666
Mailing Address - Fax:
Practice Address - Street 1:24 S 1100 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1562
Practice Address - Country:US
Practice Address - Phone:801-355-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
UT13775607-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program