Provider Demographics
NPI:1619045689
Name:FISHELL, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FISHELL
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 1:2505 ANTHEM VILLAGE DR
Mailing Address - Street 2:SUITE E625
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-932-0606
Mailing Address - Fax:702-932-0605
Practice Address - Street 1:2865 SIENA HEIGHTS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4167
Practice Address - Country:US
Practice Address - Phone:702-932-0606
Practice Address - Fax:702-932-0605
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9403208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018844Medicaid
NV002018844Medicaid
NVV36856Medicare PIN