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NPI Code Detail

MEDICARE: KUTHURU DESERT PAIN MANAGEMENT PC

MEDICARE: KUTHURU DESERT PAIN MANAGEMENT PC
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
1174400000XSpecialist1201NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11770534745OTHERNYPERSONAL NPI

General Provider Information

NPI Number : 1144474685
Entity Type Code : Organization
Provider Name (Legal Business Name) : KUTHURU DESERT PAIN MANAGEMENT PC
Provider Business Mailing Address
First Line : 5701 W CHARLESTON BLVD
Second Line : SUITE 207
City : LAS VEGAS
State : NV
Zip : 89146-1217
Country : US
Telephone Number : 702-240-8318
Fax Number : 702-240-8331
Provider Business Practice Location Address
First Line : 5701 W CHARLESTON BLVD
Second Line : SUITE 207
City : LAS VEGAS
State : NV
Zip : 89146-1217
Country : US
Telephone Number : 702-240-8318
Fax Number : 702-240-8331
Authorized Official
Title or Position : PRESIDENT
Name : MAHESH REDDY KUTHURU
Credential : MD
Telephone Number : 702-371-6173
Provider Enumeration Date : 11/11/2008
Last Update Date : 03/30/2012

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Directions to “KUTHURU DESERT PAIN MANAGEMENT PC ” Practice Location

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