MEDICARE: DR. RICHARD MICHAEL MICHELIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	DO3360	NV

General Provider Information

NPI Number	:	1275062747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD MICHAEL MICHELIN DO

Provider Business Mailing Address
First Line	:	2779 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4186
Country	:	US
Telephone Number	:	702-990-2290
Fax Number	:	702-990-2297

Provider Business Practice Location Address
First Line	:	2779 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4186
Country	:	US
Telephone Number	:	702-990-2290
Fax Number	:	702-990-2297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	06/09/2026

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