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NPI Code Detail

MEDICARE: CHANEL ERICSSON MD

MEDICARE: CHANEL ERICSSON MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1639017734
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANEL ERICSSON MD
Provider Business Mailing Address
First Line : 1701 W CHARLESTON BLVD STE 590
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2396
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 W CHARLESTON BLVD STE 590
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2396
Country : US
Telephone Number : 702-992-6875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ CHANEL ERICSSON MD” Practice Location

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