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Organization

MICOLER, INCORPORATED

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID LEROY PROTHRO M.D. (CEO)
(775) 322-4449
Entity
Organization

Contact information

Practice address
1715 KUENZLI ST, RENO, NV 89502-1117
(775) 857-2876
(775) 857-2878
Mailing address
5000 SMITHRIDGE DRIVE, D11, RENO, NV 89502-5654
(775) 857-2876
(775) 857-2878

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
NV
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
NV
207RI0011X
Interventional Cardiology Physician
NV
207UN0901X
Nuclear Cardiology Physician
NV

Other

Enumeration date
04/07/2014
Last updated
04/07/2014
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