MEDICARE: DR. MICHAEL PHILLIP COLLETTI M.D.

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	207RR0500X	Rheumatology Physician	5563	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	660002079	OTHER	NV	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1306033931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PHILLIP COLLETTI M.D.

Provider Business Mailing Address
First Line	:	4580 S EASTERN AVE
Second Line	:	#29
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6100
Country	:	US
Telephone Number	:	702-734-2242
Fax Number	:	702-737-7690

Provider Business Practice Location Address
First Line	:	4580 S EASTERN AVE
Second Line	:	#29
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6100
Country	:	US
Telephone Number	:	702-734-2242
Fax Number	:	702-737-7690

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

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	07/17/2013

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