MEDICARE: DR. BHUVANA M KITTUSAMY M.D.

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	2085R0202X	Diagnostic Radiology Physician	10926	NV

General Provider Information

NPI Number	:	1902950702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHUVANA M KITTUSAMY M.D.

Provider Business Mailing Address
First Line	:	401 N BUFFALO DR
Second Line	:	SUITE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0310
Country	:	US
Telephone Number	:	702-254-5004
Fax Number	:	702-685-0796

Provider Business Practice Location Address
First Line	:	7500 SMOKE RANCH RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0324
Country	:	US
Telephone Number	:	702-254-5004
Fax Number	:	702-432-4005

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/01/2024

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