MEDICARE: MICHAEL CHILDS DPM

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	213E00000X	Podiatrist	75904	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480032403	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295709483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CHILDS DPM

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	702-240-8847
Fax Number	:	702-240-8790

Provider Business Practice Location Address
First Line	:	2316 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2149
Country	:	US
Telephone Number	:	702-877-8600
Fax Number	:	702-240-8790

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	12/22/2021

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Directions to “ MICHAEL CHILDS DPM” Practice Location

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