Provider Demographics
NPI:1700993771
Name:O'HANLAN, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:O'HANLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8905 S PECOS RD STE 23A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7148
Mailing Address - Country:US
Mailing Address - Phone:702-734-8311
Mailing Address - Fax:702-731-2871
Practice Address - Street 1:8905 S PECOS RD
Practice Address - Street 2:SUITE.23A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7147
Practice Address - Country:US
Practice Address - Phone:702-734-8311
Practice Address - Fax:702-731-2871
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3265207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33933Medicare PIN
NVC96409Medicare UPIN