MEDICARE: DEEPA D KORDICK MD

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	207Q00000X	Family Medicine Physician	16629	NV

General Provider Information

NPI Number	:	1396087094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA D KORDICK MD

Provider Business Mailing Address
First Line	:	8205 W WARM SPRINGS RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3646
Country	:	US
Telephone Number	:	702-616-7660
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 W WARM SPRINGS RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3646
Country	:	US
Telephone Number	:	702-616-7660
Fax Number	:	702-616-7712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	11/01/2016

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