MEDICARE: CONDOLEON SURGERY LTD.

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	208600000X	Surgery Physician	1122	NV

General Provider Information

NPI Number	:	1346465283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONDOLEON SURGERY LTD.

Provider Business Mailing Address
First Line	:	3150 N TENAYA WAY
Second Line	:	SUITE 630
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0443
Country	:	US
Telephone Number	:	702-562-0801
Fax Number	:	702-562-0802

Provider Business Practice Location Address
First Line	:	3150 N TENAYA WAY
Second Line	:	SUITE 630
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0443
Country	:	US
Telephone Number	:	702-562-0801
Fax Number	:	702-562-0802

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARRY M CONDOELON
Credential	:	D.O.
Telephone Number	:	702-562-0801

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	09/28/2007

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Directions to “CONDOLEON SURGERY LTD. ” Practice Location

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