MEDICARE: FAYLONA, GOLLARD, KAUSHAL, NYAMUSWA & PARK LTD

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	174400000X	Specialist

General Provider Information

NPI Number	:	1598776783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAYLONA, GOLLARD, KAUSHAL, NYAMUSWA & PARK LTD

Provider Business Mailing Address
First Line	:	58 N PECOS RD
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7319
Country	:	US
Telephone Number	:	702-822-2000
Fax Number	:	702-938-2238

Provider Business Practice Location Address
First Line	:	6190 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-822-2000
Fax Number	:	702-938-2238

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. RUSSELL GOLLARD
Credential	:
Telephone Number	:	702-822-2000

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	10/30/2007

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Directions to “FAYLONA, GOLLARD, KAUSHAL, NYAMUSWA & PARK LTD ” Practice Location

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