MEDICARE: MARK F SEVERINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	44505	WI
2	207VE0102X	Reproductive Endocrinology Physician	7453	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013066125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK F SEVERINO MD

Provider Business Mailing Address
First Line	:	5320 S. RAINBOW BLVD
Second Line	:	STE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1986
Country	:	US
Telephone Number	:	702-794-0073
Fax Number	:	702-794-0042

Provider Business Practice Location Address
First Line	:	5320 S. RAINBOW BLVD
Second Line	:	STE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1986
Country	:	US
Telephone Number	:	702-794-0073
Fax Number	:	702-794-0042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	04/28/2015

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Directions to “ MARK F SEVERINO MD” Practice Location

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