Healthcare Provider Details

I. General information

NPI: 1083903249
Provider Name (Legal Business Name): MICHAEL STERLING TANNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10655 PARK RUN DR STE 210
LAS VEGAS NV
89144-4590
US

IV. Provider business mailing address

10655 PARK RUN DR STE 210
LAS VEGAS NV
89144-4590
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 TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number15534
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15534
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: