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NPI Code Detail

MEDICARE: DR. LOWELL THOMAS NIEBAUM M.D.

MEDICARE: DR. LOWELL THOMAS NIEBAUM 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
1207X00000XOrthopaedic Surgery Physician2576NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2200002160OTHERR.R. MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NV2576OTHERBXBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44297372OTHERAETNA

General Provider Information

NPI Number : 1609854975
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOWELL THOMAS NIEBAUM M.D.
Provider Business Mailing Address
First Line : 2800 E DESERT INN RD
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89121-3608
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-731-0741
Provider Business Practice Location Address
First Line : 2800 E DESERT INN RD
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89121-3608
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-731-0741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 10/21/2011

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