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General NPI Number Information
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NPI Number | 1285787820
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Entity Type | Organization
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Legal Business Name | SPARKS PEDIATRIC AND ADOLESCENT MEDICINE
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 975 ROBERTA LN SUITE 101B
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City | SPARKS
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State | NV
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Zip | 89431-1894
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Country | US
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Telephone | 775-359-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 975 ROBERTA LN SUITE 101B
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City | SPARKS
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State | NV
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Zip | 89431-1894
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Country | US
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Telephone | 775-359-7111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN M WINDISCH
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Credential | MD
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Telephone | 775-359-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9023
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License Number State | NV
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