1497129258 NPI number — MICHAEL E CLIFFORD M D PROF CORP

Table of content: (NPI 1497129258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497129258 NPI number — MICHAEL E CLIFFORD M D PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL E CLIFFORD M D PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497129258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7151 CASCADE VALLEY CT
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-0496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-944-5444
Provider Business Mailing Address Fax Number:
702-944-4322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7151 CASCADE VALLEY CT
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-944-5444
Provider Business Practice Location Address Fax Number:
702-944-4322
Provider Enumeration Date:
11/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CLIFFORD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-944-5444

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  5960 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com