Healthcare Provider Details

I. General information

NPI: 1134671902
Provider Name (Legal Business Name): MICHAEL TANNER, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 W CHARLESTON BLVD STE 160
LAS VEGAS NV
89135-5002
US

IV. Provider business mailing address

10100 W CHARLESTON BLVD STE 160
LAS VEGAS NV
89135-5002
US

V. Phone/Fax

Practice location:
  • Phone: 702-686-3762
  • Fax: 913-871-9266
Mailing address:
  • Phone: 702-686-3762
  • Fax: 913-871-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFF BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-686-3762