Provider Demographics
NPI:1912355066
Name:MCGREW, MICHEAL SCOTT
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:SCOTT
Last Name:MCGREW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:702-233-7950
Mailing Address - Fax:702-233-7952
Practice Address - Street 1:653 N TOWN CENTER DR STE 418
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0518
Practice Address - Country:US
Practice Address - Phone:702-233-7950
Practice Address - Fax:702-233-7952
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912355066Medicaid