Healthcare Provider Details

I. General information

NPI: 1013198738
Provider Name (Legal Business Name): SOFIA TSELIKIS MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 01/24/2008
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

2251 N RAMPART BLVD #376
LAS VEGAS NV
89128-7640
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax:
Mailing address:
  • Phone: 702-860-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11034
License Number StateNV

VIII. Authorized Official

Name: DR. SOFIA TSELIKIS
Title or Position: PHYSICIAN
Credential:
Phone: 702-453-3799