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General NPI Number Information
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NPI Number | 1346701893
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Entity Type | Organization
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Legal Business Name | EDSEL IWAY MD LLC
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2900 W HORIZON RIDGE PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89052-5014
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Country | US
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Telephone | 702-487-7055
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 S BRONCO ST
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City | LAS VEGAS
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State | NV
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Zip | 89146-5207
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Country | US
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Telephone | 412-519-7300
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. EDSEL IWAY
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Credential | MD
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Telephone | 412-519-7300
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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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