MEDICARE: DR. STACI LEIGH MCHALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	12789	NV
2	207V00000X	Obstetrics & Gynecology Physician	MT184202	PA
3	207V00000X	Obstetrics & Gynecology Physician	MD432248	PA

General Provider Information

NPI Number	:	1033328323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACI LEIGH MCHALE MD

Provider Business Mailing Address
First Line	:	PO BOX 400476
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-0476
Country	:	US
Telephone Number	:	702-740-0500
Fax Number	:	702-740-0502

Provider Business Practice Location Address
First Line	:	8850 W SUNSET RD
Second Line	:	SUITE #110
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4897
Country	:	US
Telephone Number	:	702-740-0500
Fax Number	:	702-740-0502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	06/03/2015

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