Provider Demographics
NPI:1144284670
Name:WOOD, MICHAEL HOWARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOWARD
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3980 PLACITA DEL RICO
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2629
Mailing Address - Country:US
Mailing Address - Phone:313-268-0208
Mailing Address - Fax:
Practice Address - Street 1:2968 E RUSSELL RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2453
Practice Address - Country:US
Practice Address - Phone:702-791-3729
Practice Address - Fax:702-791-3859
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-106258208600000X
NY238116-1208600000X
MI4301033364208600000X
NV25350208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144284670Medicaid
MI1144284670Medicaid
MIB46341Medicare UPIN