MEDICARE: DEB K MUKHOPADHYAY MD PC

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	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1861539231	OTHER	NV	GROUP NPI

General Provider Information

NPI Number	:	1861539231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEB K MUKHOPADHYAY MD PC

Provider Business Mailing Address
First Line	:	653 N TOWN CENTER DR STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0516
Country	:	US
Telephone Number	:	702-233-0666
Fax Number	:	702-233-8176

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0516
Country	:	US
Telephone Number	:	702-233-0666
Fax Number	:	702-233-8176

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEB K MUKHOPADHYAY
Credential	:	MD
Telephone Number	:	702-233-0666

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/09/2007

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