MEDICARE: OKAN MEDICAL GROUP CORP

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1821284720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKAN MEDICAL GROUP CORP

Provider Business Mailing Address
First Line	:	3365 E FLAMINGO RD
Second Line	:	SUITE 4
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7440
Country	:	US
Telephone Number	:	702-454-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3365 E FLAMINGO RD
Second Line	:	SUITE 4
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7440
Country	:	US
Telephone Number	:	702-454-7043
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PEDRO MARCUELLO
Credential	:
Telephone Number	:	702-454-7043

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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Directions to “OKAN MEDICAL GROUP CORP ” Practice Location

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