Provider Demographics
NPI:1376543843
Name:MICHAEL P COLLETTI MD PC
Entity Type:Organization
Organization Name:MICHAEL P COLLETTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:COLLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-734-2242
Mailing Address - Street 1:3085 E FLAMINGO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4385
Mailing Address - Country:US
Mailing Address - Phone:702-734-2242
Mailing Address - Fax:702-737-7690
Practice Address - Street 1:3085 E FLAMINGO RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4385
Practice Address - Country:US
Practice Address - Phone:702-734-2242
Practice Address - Fax:702-737-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5563207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C95905Medicare UPIN