MEDICARE: DR. SONTUSS BUSSARATID M.D.

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	2084P0800X	Psychiatry Physician	10834	NV

General Provider Information

NPI Number	:	1043329162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONTUSS BUSSARATID M.D.

Provider Business Mailing Address
First Line	:	6161 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-6000
Fax Number	:	702-486-6248

Provider Business Practice Location Address
First Line	:	2121 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2544
Country	:	US
Telephone Number	:	702-486-5750
Fax Number	:	702-486-5769

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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