Provider Demographics
NPI:1700224326
Name:RESNICK, MICHAEL LAURENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAURENCE
Last Name:RESNICK
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 1:10306 RIO DE THULE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3265
Mailing Address - Country:US
Mailing Address - Phone:702-419-4638
Mailing Address - Fax:
Practice Address - Street 1:851 S RAMPART BLVD
Practice Address - Street 2:S. 220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4882
Practice Address - Country:US
Practice Address - Phone:702-953-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV#9536207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine