Healthcare Provider Details

I. General information

NPI: 1265826788
Provider Name (Legal Business Name): MICHAEL SASSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD # 2-641
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

8983 S KINGS HILL DR
SALT LAKE CITY UT
84121-6181
US

V. Phone/Fax

Practice location:
  • Phone: 855-864-4322
  • Fax: 888-315-4512
Mailing address:
  • Phone: 801-674-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: