Provider Demographics
NPI:1699017145
Name:PELSTER, MICHAEL WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WARREN
Last Name:PELSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2301 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4908
Mailing Address - Country:US
Mailing Address - Phone:615-424-4988
Mailing Address - Fax:615-613-0329
Practice Address - Street 1:2301 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4908
Practice Address - Country:US
Practice Address - Phone:615-327-9797
Practice Address - Fax:615-613-0329
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6456207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFP6595358OtherDEA