MEDICARE: DEB K. MUKHOPADHYAY 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	207RG0100X	Gastroenterology Physician	9249	NV

General Provider Information

NPI Number	:	1104816214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEB K. MUKHOPADHYAY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33907
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-3907
Country	:	US
Telephone Number	:	702-233-0666
Fax Number	:	702-233-8176

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR
Second Line	:	SUITE #604
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0514
Country	:	US
Telephone Number	:	702-233-0666
Fax Number	:	702-233-8176

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/25/2013

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