MEDICARE: MICHEAL STAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205250933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEAL STAGE

Provider Business Mailing Address
First Line	:	3406 CINNAMON CREEK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3520
Country	:	US
Telephone Number	:	702-994-8501
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 CINNAMON CREEK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3520
Country	:	US
Telephone Number	:	702-994-8501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/21/2014

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Directions to “ MICHEAL STAGE ” Practice Location

Language	Start Address	Practice Location

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