Healthcare Provider Details

I. General information

NPI: 1033841176
Provider Name (Legal Business Name): NICHOLAS CIURCZAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SHADOW LN
LAS VEGAS NV
89106-4119
US

IV. Provider business mailing address

2426 ANTLER POINT DR
HENDERSON NV
89074-6256
US

V. Phone/Fax

Practice location:
  • Phone: 702-388-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO3840
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSL1888
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: