Provider Demographics
NPI:1083903249
Name:TANNER, MICHAEL STERLING (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STERLING
Last Name:TANNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8170 W SAHARA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1981
Mailing Address - Country:US
Mailing Address - Phone:702-686-3762
Mailing Address - Fax:913-871-9266
Practice Address - Street 1:8170 W SAHARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1981
Practice Address - Country:US
Practice Address - Phone:702-686-3762
Practice Address - Fax:913-871-9266
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV155342084P0015X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry