Provider Demographics
NPI:1871911875
Name:MICOLER, INCORPORATED
Entity type:Organization
Organization Name:MICOLER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:PROTHRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-4449
Mailing Address - Street 1:5000 SMITHRIDGE DRIVE
Mailing Address - Street 2:D11
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5654
Mailing Address - Country:US
Mailing Address - Phone:775-857-2876
Mailing Address - Fax:775-857-2878
Practice Address - Street 1:1715 KUENZLI ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1117
Practice Address - Country:US
Practice Address - Phone:775-857-2876
Practice Address - Fax:775-857-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207RC0000X, 207RI0001X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty