MEDICARE: MICHAEL P COLLETTI MD PC

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	207RR0500X	Rheumatology Physician	5563	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK5469	OTHER	NV	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1609876663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL P COLLETTI MD PC

Provider Business Mailing Address
First Line	:	4580 S EASTERN AVE
Second Line	:	#29
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6100
Country	:	US
Telephone Number	:	702-734-2242
Fax Number	:	702-737-7690

Provider Business Practice Location Address
First Line	:	4580 S EASTERN AVE
Second Line	:	#29
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6100
Country	:	US
Telephone Number	:	702-734-2242
Fax Number	:	702-737-7690

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PHILLIP COLLETTI
Credential	:	MD
Telephone Number	:	702-734-2242

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	02/25/2009

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