Healthcare Provider Details

I. General information

NPI: 1841793676
Provider Name (Legal Business Name): NATHAN ELLIOTT KIRSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD STE 230
LAS VEGAS NV
89102-2353
US

IV. Provider business mailing address

1111 MEDICAL PLAZA DR STE 250
THE WOODLANDS TX
77380-3477
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2345
  • Fax:
Mailing address:
  • Phone: 281-296-8788
  • Fax: 281-419-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU7890
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberU7890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: