Provider Demographics
NPI:1376723056
Name:YUDEZ, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YUDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 280 E
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8932
Mailing Address - Country:US
Mailing Address - Phone:702-240-8646
Mailing Address - Fax:702-932-8347
Practice Address - Street 1:9010 W CHEYENNE AVE
Practice Address - Street 2:SUITE 280 E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8932
Practice Address - Country:US
Practice Address - Phone:702-240-8646
Practice Address - Fax:702-932-8347
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D24774Medicare UPIN