MEDICARE: CORNELL V. CALINESCU MD

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	207P00000X	Emergency Medicine Physician	ME87540	FL
2	207P00000X	Emergency Medicine Physician	16111	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16111	OTHER	NV	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	81104	OTHER	FL	BC/BS

General Provider Information

NPI Number	:	1457339004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORNELL V. CALINESCU MD

Provider Business Mailing Address
First Line	:	2665 S MONTE CRISTO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2948
Country	:	US
Telephone Number	:	954-649-5739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2665 S MONTE CRISTO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2948
Country	:	US
Telephone Number	:	954-649-5739
Fax Number	:	954-239-5378

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	08/19/2019

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