Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0104 | NV |
NPI | 1023066842 |
---|---|
Provider Name | Dr. Michael Francis Federico |
First Address | Las Vegas, NV 89129-3626 |
Second Address | N. Las Vegas, NV 89191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T41073 | (02) |