Provider Demographics
NPI:1376525352
Name:GONZALEZ, MIGUEL A (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 W SAHARA AVE # 260
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5744
Mailing Address - Country:US
Mailing Address - Phone:702-321-5293
Mailing Address - Fax:702-463-1507
Practice Address - Street 1:9030 W SAHARA AVE # 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5744
Practice Address - Country:US
Practice Address - Phone:702-321-5293
Practice Address - Fax:702-463-1507
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9622208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39386Medicare PIN
NVH55753Medicare UPIN
NVCM479ZMedicare PIN