Healthcare Provider Details

I. General information

NPI: 1548398647
Provider Name (Legal Business Name): MICHAEL J GUNTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE SUITE 445
LAS VEGAS NV
89128-4337
US

IV. Provider business mailing address

7455 W WASHINGTON AVE SUITE 445
LAS VEGAS NV
89128-4337
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-5138
  • Fax: 702-804-5364
Mailing address:
  • Phone: 702-804-5138
  • Fax: 702-804-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number8113
License Number StateNV

VIII. Authorized Official

Name: MICHAEL J GUNTER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-228-7117