MEDICARE: MGG AND GROUPS

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1033617824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MGG AND GROUPS

Provider Business Mailing Address
First Line	:	2255 RENAISSANCE DR STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6751
Country	:	US
Telephone Number	:	702-434-5114
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 RENAISSANCE DR STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6751
Country	:	US
Telephone Number	:	702-434-5114
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY-GRACE G GAERLAN
Credential	:
Telephone Number	:	702-434-5114

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	03/11/2020

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Directions to “MGG AND GROUPS ” Practice Location

Language	Start Address	Practice Location

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