MEDICARE: DR. MICHAEL FISHELL M.D.

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	208VP0014X	Interventional Pain Medicine Physician	9403	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1619045689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FISHELL M.D.

Provider Business Mailing Address
First Line	:	2505 ANTHEM VILLAGE DR
Second Line	:	SUITE E625
City	:	HENDERSON
State	:	NV
Zip	:	89052-5505
Country	:	US
Telephone Number	:	702-932-0606
Fax Number	:	702-932-0605

Provider Business Practice Location Address
First Line	:	2865 SIENA HEIGHTS DR
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89052-4167
Country	:	US
Telephone Number	:	702-932-0606
Fax Number	:	702-932-0605

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	12/12/2016

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