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General NPI Number Information
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NPI Number | 1235843608
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARE PHYSICIANS
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 5506 S FORT APACHE RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-7673
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Country | US
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Telephone | 702-533-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 5375 S FORT APACHE RD STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89148-7624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IVAN GOLDSMITH
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Credential | MD
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Telephone | 702-960-5762
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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 |
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License Number State |
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