MEDICARE: THOMAS S PULICE MPA-C

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	363A00000X	Physician Assistant	PA865	NV

General Provider Information

NPI Number	:	1740293810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS S PULICE MPA-C

Provider Business Mailing Address
First Line	:	2245 MAPLE ROSE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0190
Country	:	US
Telephone Number	:	702-363-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 MAPLE ROSE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0190
Country	:	US
Telephone Number	:	702-363-4001
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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Directions to “ THOMAS S PULICE MPA-C” Practice Location

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