Provider Demographics
NPI:1538393053
Name:CLINICAL INFECTIOUS DISEASES SPECIALISTS (ITANI) PC
Entity type:Organization
Organization Name:CLINICAL INFECTIOUS DISEASES SPECIALISTS (ITANI) PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-200-3232
Mailing Address - Street 1:2435 FIRE MESA ST
Mailing Address - Street 2:STE. 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9009
Mailing Address - Country:US
Mailing Address - Phone:702-968-2437
Mailing Address - Fax:702-479-1796
Practice Address - Street 1:2435 FIRE MESA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9009
Practice Address - Country:US
Practice Address - Phone:702-487-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCD534AMedicare PIN