MEDICARE: DESERT CARDIOVASCULAR SURGERY

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	2086S0129X	Vascular Surgery Physician
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

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	:	1083624688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT CARDIOVASCULAR SURGERY

Provider Business Mailing Address
First Line	:	9811 W CHARLESTON BLVD
Second Line	:	#2-768
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:	702-450-7070
Fax Number	:	702-450-7072

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5192
Country	:	US
Telephone Number	:	702-450-7070
Fax Number	:	702-450-7072

Authorized Official
Title or Position	:	OWNER
Name	:	HAZEM Y AFIFI
Credential	:	M.D.
Telephone Number	:	702-450-7070

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/10/2015

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