| Doctor Name: | DR. MICHAEL FRANCIS FEDERICO |
| NPI Number: | 1023066842 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 0104 |
| Business Practice Address: | 4001 N. Las Vegas Blvd. Mofh Nellis Afb 3c N. Las Vegas, NV - 89191 |
| Business Phone Number: | 7026533134 |
| Business Fax Number: | 7026532790 |
| Mailing Address: | 8835 Hickam Ave, LAS VEGAS |
| State: | NV |
| Postal Code: | 891293626 |
| Phone Number: | 7026579228 |
| Fax Number: | 7026579586 |
| NPI Enumeration Date: | 05/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 0104 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |