MEDICARE: CHILDRENS UROLOGY ASSOCIATES, LLC

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	2088P0231X	Pediatric Urology Physician	6402	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134324668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS UROLOGY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	6670 S TENAYA WAY STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1964
Country	:	US
Telephone Number	:	702-369-4999
Fax Number	:	702-369-2993

Provider Business Practice Location Address
First Line	:	6670 S TENAYA WAY STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1964
Country	:	US
Telephone Number	:	702-369-4999
Fax Number	:	702-369-2993

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. GEORGE GANESAN
Credential	:	MD
Telephone Number	:	702-369-4999

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	08/12/2020

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Directions to “CHILDRENS UROLOGY ASSOCIATES, LLC ” Practice Location

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