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NPI Code Detail

MEDICARE: DR. ADAM JOSEPH ANTFLICK D.O.

MEDICARE: DR. ADAM JOSEPH ANTFLICK D.O.
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
1207LP2900XPain Medicine (Anesthesiology) Physician56552NV
2208VP0014XInterventional Pain Medicine PhysicianDO2196NV

General Provider Information

NPI Number : 1114274057
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM JOSEPH ANTFLICK D.O.
Provider Business Mailing Address
First Line : 3157 N RAINBOW BLVD
Second Line : # 518
City : LAS VEGAS
State : NV
Zip : 89108-4578
Country : US
Telephone Number : 702-386-4700
Fax Number : 702-386-4701
Provider Business Practice Location Address
First Line : 7220 S CIMARRON RD STE 270
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2160
Country : US
Telephone Number : 702-386-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2012
Last Update Date : 11/23/2020

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