Healthcare Provider Details

I. General information

NPI: 1215513155
Provider Name (Legal Business Name): BRIAN KASZUBA MD, DABFM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 EBB TIDE CIR
LAS VEGAS NV
89123-1132
US

IV. Provider business mailing address

198 EBB TIDE CIR
LAS VEGAS NV
89123-1132
US

V. Phone/Fax

Practice location:
  • Phone: 725-299-4777
  • Fax: 725-226-2398
Mailing address:
  • Phone: 725-299-4777
  • Fax: 725-226-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25897
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number25897
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: