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General NPI Number Information
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NPI Number | 1043217581
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Entity Type | Individual
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Provider Name | MICHAEL SALVATORE FESTENESE P.A.C.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 8571 W LAKE MEAD BLVD STE #120
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City | LAS VEGAS
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State | NV
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Zip | 89128-7631
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Country | US
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Telephone | 702-360-5194
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Fax | 702-319-4754
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Provider Business Mailing Address
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Address Line | 8571 W LAKE MEAD BLVD SUITE #120
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City | LAS VEGAS
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State | NV
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Zip | 89128-7631
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Country | US
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Telephone | 702-360-5194
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Fax | 702-319-4754
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 513
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License Number State | NV
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