MEDICARE: DR. SANGHAMITRA BASU 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	207L00000X	Anesthesiology Physician	11401	NV
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	11401	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

General Provider Information

NPI Number	:	1952389074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANGHAMITRA BASU M.D.

Provider Business Mailing Address
First Line	:	6955 N DURANGO DR
Second Line	:	SUITE 1115-301
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4411
Country	:	US
Telephone Number	:	702-362-7246
Fax Number	:	702-362-7272

Provider Business Practice Location Address
First Line	:	2435 FIRE MESA ST
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9009
Country	:	US
Telephone Number	:	702-362-7246
Fax Number	:	702-362-7272

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/22/2014

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