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NPI Code Detail

MEDICARE: SANGHAMITRA BASU MD PC

MEDICARE: SANGHAMITRA BASU 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
1207LP2900XPain Medicine (Anesthesiology) Physician
2207L00000XAnesthesiology Physician
3207LA0401XAddiction Medicine (Anesthesiology) Physician
4363L00000XNurse Practitioner
5208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1215159306
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANGHAMITRA BASU MD PC
Provider Business Mailing Address
First Line : 6955 N. DURANGO DRIVE
Second Line : STE #1115-301
City : LAS VEGAS
State : NV
Zip : 89149-4411
Country : US
Telephone Number : 702-362-7246
Fax Number : 702-362-7272
Provider Business Practice Location Address
First Line : 2435 FIRE MESA ST
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89128-9009
Country : US
Telephone Number : 702-362-7246
Fax Number : 702-362-7272
Authorized Official
Title or Position : PRINCIPAL
Name : DR. SANGHAMITRA BASU
Credential : M.D.
Telephone Number : 702-362-7246
Provider Enumeration Date : 05/02/2007
Last Update Date : 04/17/2014

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Directions to “SANGHAMITRA BASU MD PC ” Practice Location

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