Provider Demographics
NPI:1568774792
Name:MICHAEL, ANU P
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:P
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:STE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-7878
Practice Address - Fax:775-982-4196
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12511249OtherCAQH