Provider Demographics
NPI:1902080989
Name:DANIELIAN, MICHELLE PERISSE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PERISSE
Last Name:DANIELIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:PERISSE
Other - Last Name:BUSSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10120 S EASTERN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3951
Mailing Address - Country:US
Mailing Address - Phone:702-483-6200
Mailing Address - Fax:702-483-6202
Practice Address - Street 1:10120 S EASTERN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3951
Practice Address - Country:US
Practice Address - Phone:702-483-6200
Practice Address - Fax:702-483-6202
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14800207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV14800OtherNSBME