MEDICARE: STEFAN NATHAN CHOCK MD

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	2086S0102X	Surgical Critical Care Physician	11562	NV
2	208600000X	Surgery Physician	11562	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811966062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN NATHAN CHOCK MD

Provider Business Mailing Address
First Line	:	3131 LA CANADA ST STE 217
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2579
Country	:	US
Telephone Number	:	702-369-7152
Fax Number	:	702-369-7153

Provider Business Practice Location Address
First Line	:	3131 LA CANADA ST STE 217
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2579
Country	:	US
Telephone Number	:	702-369-7152
Fax Number	:	702-369-7153

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	04/10/2020

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