MEDICARE: NV SURGICALIST 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1578229456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NV SURGICALIST PLLC

Provider Business Mailing Address
First Line	:	PO BOX 21647
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-1647
Country	:	US
Telephone Number	:	813-530-5043
Fax Number	:

Provider Business Practice Location Address
First Line	:	7010 SMOKE RANCH RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8399
Country	:	US
Telephone Number	:	725-225-0995
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MIT DESAI
Credential	:	MD
Telephone Number	:	813-530-5043

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	12/17/2021

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Directions to “NV SURGICALIST PLLC ” Practice Location

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