MEDICARE: LAURA G GITLIN 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	207RG0100X	Gastroenterology Physician	7692	NV
2	207RG0100X	Gastroenterology Physician	35.064894	OH

General Provider Information

NPI Number	:	1023017696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA G GITLIN MD

Provider Business Mailing Address
First Line	:	7110 SMOKE RANCH ROAD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3157
Country	:	US
Telephone Number	:	702-869-5544
Fax Number	:	702-869-9993

Provider Business Practice Location Address
First Line	:	7110 SMOKE RANCH ROAD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3157
Country	:	US
Telephone Number	:	702-869-5544
Fax Number	:	702-869-9993

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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