MEDICARE: HENRI WETSELAAR, MD, PC

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	3432	NV

General Provider Information

NPI Number	:	1124217245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRI WETSELAAR, MD, PC

Provider Business Mailing Address
First Line	:	3681 FORESTCREST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4954
Country	:	US
Telephone Number	:	702-480-9794
Fax Number	:	702-434-2047

Provider Business Practice Location Address
First Line	:	2881 S VALLEY VW
Second Line	:	SUITE 16
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0175
Country	:	US
Telephone Number	:	702-480-9794
Fax Number	:	702-434-2047

Authorized Official
Title or Position	:	CEO
Name	:	HENRI WETSELAAR
Credential	:	MD
Telephone Number	:	702-434-2028

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	04/16/2008

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