Healthcare Provider Details

I. General information

NPI: 1124067491
Provider Name (Legal Business Name): MICHAEL H SONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 ELM ST SUITE 202
RENO NV
89503-4522
US

IV. Provider business mailing address

343 ELM ST SUITE 202
RENO NV
89503-4522
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number10771
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: