Basic Information
| Provider Information | |||||||||
| NPI: | 1720303431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL H SONG MD LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED NEUROSURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753236100 | ||||||||
| FaxNumber: | 7753236118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 MEDICAL PKWY | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897034648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753236100 | ||||||||
| FaxNumber: | 7753236118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | SONG | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7753236100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 10771 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 6345810002 | 01 | NV | DME | OTHER |