MEDICARE: CLINICAL INFECTIOUS DISEASES SPECIALISTS (ITANI) 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
1	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1538393053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL INFECTIOUS DISEASES SPECIALISTS (ITANI) PC

Provider Business Mailing Address
First Line	:	2435 FIRE MESA ST
Second Line	:	STE. 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9009
Country	:	US
Telephone Number	:	702-968-2437
Fax Number	:	702-479-1796

Provider Business Practice Location Address
First Line	:	2435 FIRE MESA ST
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9009
Country	:	US
Telephone Number	:	702-487-7055
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PAGE MCCALISTER
Credential	:
Telephone Number	:	725-200-3232

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	06/10/2020

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