Provider Demographics
NPI:1023066842
Name:FEDERICO, MICHAEL FRANCIS (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:FEDERICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8835 HICKAM AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3626
Mailing Address - Country:US
Mailing Address - Phone:702-657-9228
Mailing Address - Fax:702-657-9586
Practice Address - Street 1:4001 N. LAS VEGAS BLVD.
Practice Address - Street 2:MOFH NELLIS AFB 3C
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-653-3134
Practice Address - Fax:702-653-2790
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0104213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V37891Medicare ID - Type Unspecified
T41073Medicare UPIN