MEDICARE: PHILANDER MEDICAL ASSOCIATES, INC.

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	207Q00000X	Family Medicine Physician	8535	NV

General Provider Information

NPI Number	:	1568542504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILANDER MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2481 PROFESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0825
Country	:	US
Telephone Number	:	702-382-1599
Fax Number	:	702-240-4962

Provider Business Practice Location Address
First Line	:	2481 PROFESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0825
Country	:	US
Telephone Number	:	702-382-1599
Fax Number	:	702-240-4962

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER H PHILANDER
Credential	:	M.D.
Telephone Number	:	702-382-1599

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/17/2013

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