MEDICARE: JOHN ISAIAH OREILLY 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	207R00000X	Internal Medicine Physician	21365	NV
2	207RI0200X	Infectious Disease Physician	21365	NV

General Provider Information

NPI Number	:	1356579155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ISAIAH OREILLY M.D.

Provider Business Mailing Address
First Line	:	622 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	2435 FIRE MESA ST STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9009
Country	:	US
Telephone Number	:	702-968-2437
Fax Number	:	702-479-1796

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	09/24/2021

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