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General NPI Number Information
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NPI Number | 1699102442
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Entity Type | Organization
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Legal Business Name | KACEY MD LLC
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 1033 RAILROAD FLAT CT
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City | LAS VEGAS
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State | NV
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Zip | 89138-4521
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Country | US
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Telephone | 312-823-6126
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 RAILROAD FLAT CT
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City | LAS VEGAS
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State | NV
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Zip | 89138-4521
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Country | US
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Telephone | 312-823-6126
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KASEY LAZ ABANONU
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Credential | MD
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Telephone | 312-823-6126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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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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