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General NPI Number Information
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NPI Number | 1740268556
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Entity Type | Individual
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Provider Name | KENNETH E MCINTYRE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1707 W CHARLESTON BLVD #160, PATIENT CARE CENTER
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City | LAS VEGAS
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State | NV
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Zip | 89102-2351
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Country | US
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Telephone | 702-671-5150
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Fax | 702-684-6493
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Provider Business Mailing Address
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Address Line | 2040 W CHARLESTON BLVD #601
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City | LAS VEGAS
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State | NV
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Zip | 89102-2227
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Country | US
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Telephone | 702-671-2274
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Fax | 702-384-7506
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 10314
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License Number State | NV
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