MEDICARE: KRISTIN M SANDERSON M.D.

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	12266	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	:	1700938354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN M SANDERSON M.D.

Provider Business Mailing Address
First Line	:	5701 W CHARLESTON BLVD
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1217
Country	:	US
Telephone Number	:	702-877-0814
Fax Number	:	702-877-0113

Provider Business Practice Location Address
First Line	:	5701 W CHARLESTON BLVD
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1217
Country	:	US
Telephone Number	:	702-877-0814
Fax Number	:	702-877-0113

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	04/18/2008

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