MEDICARE: GEORGE DALSUKE MOMII 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	2085R0202X	Diagnostic Radiology Physician	6447	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	:	1215937974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE DALSUKE MOMII M.D.

Provider Business Mailing Address
First Line	:	PO BOX 36900
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6900
Country	:	US
Telephone Number	:	702-732-6000
Fax Number	:	702-243-7531

Provider Business Practice Location Address
First Line	:	6925 N. DURANGO DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149
Country	:	US
Telephone Number	:	702-732-6000
Fax Number	:	702-243-7531

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/07/2013

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