MEDICARE: KITTUSAMY 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	207RC0000X	Cardiovascular Disease Physician
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1972714970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KITTUSAMY LLC

Provider Business Mailing Address
First Line	:	7660 W CHEYENNE AVE STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6757
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	:

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MARIA MARTINEZ
Credential	:
Telephone Number	:	702-254-5004

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	09/01/2021

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Directions to “KITTUSAMY LLC ” Practice Location

Language	Start Address	Practice Location

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