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NPI Code Detail

MEDICARE: MICHELSON MEDICAL PLLC

MEDICARE: MICHELSON MEDICAL PLLC
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
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1962265561
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHELSON MEDICAL PLLC
Provider Business Mailing Address
First Line : 9811 W CHARLESTON BLVD
Second Line : PO BOX 705
City : LAS VEGAS
State : NV
Zip : 89117
Country : US
Telephone Number : 775-848-5995
Fax Number :
Provider Business Practice Location Address
First Line : 2496 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2179
Country : US
Telephone Number : 775-848-5995
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : SHANNON MICHELSON
Credential : MD
Telephone Number : 775-848-5995
Provider Enumeration Date : 02/05/2024
Last Update Date : 02/05/2024

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