MEDICARE: THE FALCON TEAM LLC

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	213EP1101X	Primary Podiatric Medicine Podiatrist

General Provider Information

NPI Number	:	1831761493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FALCON TEAM LLC

Provider Business Mailing Address
First Line	:	9225 WHITEKIRK PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8719
Country	:	US
Telephone Number	:	619-675-3694
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 WHITEKIRK PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8719
Country	:	US
Telephone Number	:	619-675-3694
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	NEIL COLICA
Credential	:
Telephone Number	:	619-675-3694

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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Directions to “THE FALCON TEAM LLC ” Practice Location

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