Provider Demographics
NPI:1861693855
Name:MENDEZ, KIRK T (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:T
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PALOMINO LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4842
Mailing Address - Country:US
Mailing Address - Phone:702-474-7200
Mailing Address - Fax:702-474-0009
Practice Address - Street 1:2680 CRIMSON CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0841
Practice Address - Country:US
Practice Address - Phone:702-474-7200
Practice Address - Fax:702-474-0009
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12438207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV555554Medicaid
NVV104459Medicare PIN
NVI01374Medicare UPIN