MEDICARE: POPULAR MEDICAL CONSULTANT CORP

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	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	6939	NV
2	207Q00000X	Family Medicine Physician	6939	NV
3	207R00000X	Internal Medicine Physician	6939	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	:	1114119351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPULAR MEDICAL CONSULTANT CORP

Provider Business Mailing Address
First Line	:	1301 MARYLAND PARKWAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-458-3800
Fax Number	:	702-642-5671

Provider Business Practice Location Address
First Line	:	1301 MARYLAND PARKWAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-458-3800
Fax Number	:	702-642-5671

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JAVIER KATSUMI KAMISATO
Credential	:	M.D.
Telephone Number	:	702-458-3800

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	05/15/2012

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Directions to “POPULAR MEDICAL CONSULTANT CORP ” Practice Location

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