MEDICARE: MICHELLE D CONGER DO

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	207Q00000X	Family Medicine Physician	762	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V113510	OTHER	NV	MEDICARE SMA

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	:	1730152703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE D CONGER DO

Provider Business Mailing Address
First Line	:	P.O. BOX 25645
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89119
Country	:	US
Telephone Number	:	702-877-5199
Fax Number	:	702-984-5194

Provider Business Practice Location Address
First Line	:	4750 W OAKEY BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1535
Country	:	US
Telephone Number	:	702-877-5199
Fax Number	:	702-984-5184

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	11/16/2021

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Directions to “ MICHELLE D CONGER DO” Practice Location

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