Healthcare Provider Details

I. General information

NPI: 1902886385
Provider Name (Legal Business Name): KENNETH E MISCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W HORIZON RIDGE PKWY
HENDERSON NV
89052-5075
US

IV. Provider business mailing address

2350 W HORIZON RIDGE PKWY
HENDERSON NV
89052-5075
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-8556
  • Fax: 702-564-4485
Mailing address:
  • Phone: 702-564-8556
  • Fax: 702-564-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6962
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: