MEDICARE: RALPH M NIETRZEBA 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	207RP1001X	Pulmonary Disease Physician	4554	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1639128705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH M NIETRZEBA MD

Provider Business Mailing Address
First Line	:	400 N STEPHANIE ST STE 300
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6692
Country	:	US
Telephone Number	:	702-952-3350
Fax Number	:	702-952-3365

Provider Business Practice Location Address
First Line	:	9280 W SUNSET RD STE 312
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4862
Country	:	US
Telephone Number	:	702-737-5864
Fax Number	:	702-737-6885

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	03/21/2024

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