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General NPI Number Information
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NPI Number | 1144522418
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE CONSULTANTS
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 6726 COLEY AVE
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City | LAS VEGAS
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State | NV
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Zip | 89146-6514
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Country | US
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Telephone | 702-252-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 840 S RANCHO DR # 4-336
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City | LAS VEGAS
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State | NV
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Zip | 89106-3837
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Country | US
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Telephone | 702-252-0670
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JOHN PETRUSO
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Credential | M.D.
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Telephone | 702-252-0670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 6283
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License Number State | NV
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