MEDICARE: MITCHELL FADOUL KEAMY III 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	207L00000X	Anesthesiology Physician	5653	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P0169392	OTHER	NV	RAILROAD MEDICARE

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	:	1265431241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL FADOUL KEAMY III M.D.

Provider Business Mailing Address
First Line	:	3157 N RAINBOW BLVD # 518
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	702-877-8661
Fax Number	:	702-877-5140

Provider Business Practice Location Address
First Line	:	2850 S MOJAVE RD LOT A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-386-4700
Fax Number	:	702-386-4701

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/27/2018

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