MEDICARE: KITTUSAMY, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207QB0002X	Obesity Medicine (Family Medicine) Physician
2	207RC0000X	Cardiovascular Disease Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1558749168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KITTUSAMY, LLP

Provider Business Mailing Address
First Line	:	401 N BUFFALO DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0310
Country	:	US
Telephone Number	:	702-853-5681
Fax Number	:	702-675-6971

Provider Business Practice Location Address
First Line	:	401 N BUFFALO DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0310
Country	:	US
Telephone Number	:	702-853-5681
Fax Number	:	702-675-6971

Authorized Official
Title or Position	:	OWNER
Name	:	PREM KITTUSAMY
Credential	:	MD
Telephone Number	:	702-589-2750

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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