Healthcare Provider Details

I. General information

NPI: 1710933213
Provider Name (Legal Business Name): MICHAEL H SONG MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10509 PROFESSIONAL CIRCLE SUITE 101
RENO NV
89521-4883
US

IV. Provider business mailing address

PO BOX 19908
RENO NV
89511-2554
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-6100
  • Fax: 775-323-6118
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL H SONG
Title or Position: MD/PRESIDENT
Credential: M.D.
Phone: 775-323-6100