Provider Demographics
NPI:1144557836
Name:FRONTLINE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:FRONTLINE MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:702-233-6661
Mailing Address - Street 1:PO BOX 34478
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-233-6661
Mailing Address - Fax:702-233-3055
Practice Address - Street 1:3150 N TENAYA WAY STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0463
Practice Address - Country:US
Practice Address - Phone:702-233-6661
Practice Address - Fax:702-233-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty