MEDICARE: CARLOS T. TISBE, M.D., PLLC

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	207L00000X	Anesthesiology Physician	10770	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	:	1205024437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS T. TISBE, M.D., PLLC

Provider Business Mailing Address
First Line	:	3230 E FLAMINGO RD
Second Line	:	334
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4320
Country	:	US
Telephone Number	:	702-454-8236
Fax Number	:	702-454-8279

Provider Business Practice Location Address
First Line	:	3230 E FLAMINGO RD
Second Line	:	334
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4320
Country	:	US
Telephone Number	:	702-454-8236
Fax Number	:	702-454-8279

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CARLOS T TISBE
Credential	:	M.D.
Telephone Number	:	702-454-8236

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	03/27/2009

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