MEDICARE: CAESARS PALACE MEDICAL CLINIC

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	207R00000X	Internal Medicine Physician	1867	MI

General Provider Information

NPI Number	:	1053485409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAESARS PALACE MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	3570 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8924
Country	:	US
Telephone Number	:	702-731-7372
Fax Number	:	702-735-2272

Provider Business Practice Location Address
First Line	:	3570 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8924
Country	:	US
Telephone Number	:	702-731-7372
Fax Number	:	702-735-2272

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH L FINK
Credential	:	M.D.
Telephone Number	:	702-731-7372

Provider Enumeration Date	:	11/19/2006
Last Update Date	:	08/22/2020

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