Healthcare Provider Details

I. General information

NPI: 1679551147
Provider Name (Legal Business Name): BRIAN E SYSKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

PO BOX 1569
LAS VEGAS NV
89125-1569
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5025
  • Fax: 702-255-5015
Mailing address:
  • Phone: 702-671-6809
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number35086839
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12392
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number12392
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: