Healthcare Provider Details

I. General information

NPI: 1376543843
Provider Name (Legal Business Name): MICHAEL P COLLETTI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 E FLAMINGO RD SUITE A
LAS VEGAS NV
89121-4385
US

IV. Provider business mailing address

3085 E FLAMINGO RD SUITE A
LAS VEGAS NV
89121-4385
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-2242
  • Fax: 702-737-7690
Mailing address:
  • Phone: 702-734-2242
  • Fax: 702-737-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5563
License Number StateNV

VIII. Authorized Official

Name: MICHAEL PHILLIP COLLETTI
Title or Position: OWNER
Credential: MD
Phone: 702-734-2242