Provider Demographics
NPI:1730510447
Name:MARY KIEPERT, MD. LTD
Entity type:Organization
Organization Name:MARY KIEPERT, MD. LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-873-1899
Mailing Address - Street 1:2810 S JONES BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5648
Mailing Address - Country:US
Mailing Address - Phone:702-873-1899
Mailing Address - Fax:702-873-7476
Practice Address - Street 1:2810 S JONES BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5648
Practice Address - Country:US
Practice Address - Phone:702-873-1899
Practice Address - Fax:702-873-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501822Medicaid
NV100501918Medicaid