Provider Demographics
NPI:1306033931
Name:COLLETTI, MICHAEL PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILLIP
Last Name:COLLETTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4580 S EASTERN AVE
Mailing Address - Street 2:#29
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6100
Mailing Address - Country:US
Mailing Address - Phone:702-734-2242
Mailing Address - Fax:702-737-7690
Practice Address - Street 1:4580 S EASTERN AVE
Practice Address - Street 2:#29
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6100
Practice Address - Country:US
Practice Address - Phone:702-734-2242
Practice Address - Fax:702-737-7690
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2013-07-17
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Provider Licenses
StateLicense IDTaxonomies
NV5563207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV660002079OtherMEDICARE RAILROAD
NV660002079OtherMEDICARE RAILROAD