Provider Demographics
NPI:1407352859
Name:MICHAEL A BENASSI MD PLLC
Entity Type:Organization
Organization Name:MICHAEL A BENASSI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-496-5623
Mailing Address - Street 1:2420 PROFESSIONAL CT STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0837
Mailing Address - Country:US
Mailing Address - Phone:702-648-9400
Mailing Address - Fax:702-636-0249
Practice Address - Street 1:2420 PROFESSIONAL CT STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0837
Practice Address - Country:US
Practice Address - Phone:702-648-9400
Practice Address - Fax:702-636-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty