Healthcare Provider Details

I. General information

NPI: 1104845569
Provider Name (Legal Business Name): MICHAEL JOHNATHON ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2ND ST STE 300
RENO NV
89502-1198
US

IV. Provider business mailing address

850 HARVARD WAY
RENO NV
89502-2055
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-3900
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG75995
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number18506
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: