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NPI Code Detail

MEDICARE: DR. DONALD SIMON KWALICK M.D.,MPH,FACPM

MEDICARE:  DR. DONALD SIMON KWALICK  M.D.,MPH,FACPM
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
12083P0901XPublic Health & General Preventive Medicine Physician6137NV

General Provider Information

NPI Number : 1093008674
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD SIMON KWALICK M.D.,MPH,FACPM
Provider Business Mailing Address
First Line : 3025 PLAZA DE MONTE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-4046
Country : US
Telephone Number : 702-227-0259
Fax Number : 702-227-8880
Provider Business Practice Location Address
First Line : 3025 PLAZA DE MONTE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-4046
Country : US
Telephone Number : 702-227-0259
Fax Number : 702-227-8880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2011
Last Update Date : 05/16/2011

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Directions to “ DR. DONALD SIMON KWALICK M.D.,MPH,FACPM” Practice Location

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