Provider Demographics
NPI:1730152703
Name:CONGER, MICHELLE D (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:CONGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 25645
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119
Mailing Address - Country:US
Mailing Address - Phone:702-877-5199
Mailing Address - Fax:702-984-5194
Practice Address - Street 1:4750 W OAKEY BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1535
Practice Address - Country:US
Practice Address - Phone:702-877-5199
Practice Address - Fax:702-984-5184
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV113510OtherMEDICARE SMA
NV002019697Medicaid
NV002019697Medicaid
NVV113510OtherMEDICARE SMA