MEDICARE: DR. SETH K ADJOVU MD

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	208000000X	Pediatrics Physician	10335	NV
2	208M00000X	Hospitalist Physician	10335	NV
3	207R00000X	Internal Medicine Physician	10335	NV

General Provider Information

NPI Number	:	1962407429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH K ADJOVU MD

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 220
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0329
Country	:	US
Telephone Number	:	702-602-7828
Fax Number	:	702-399-8431

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/30/2024

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