Provider Demographics
NPI:1982259040
Name:MICHAEL'S INTEGRATED MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MICHAEL'S INTEGRATED MEDICAL GROUP PLLC
Other - Org Name:PAHRUMP SPINE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-727-7959
Mailing Address - Street 1:2780 HOMESTEAD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5464
Mailing Address - Country:US
Mailing Address - Phone:775-727-7959
Mailing Address - Fax:775-727-7960
Practice Address - Street 1:2780 HOMESTEAD RD STE 104
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5464
Practice Address - Country:US
Practice Address - Phone:775-727-7959
Practice Address - Fax:775-727-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty