MEDICARE: DR. DEMIAN GITNACHT 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
1	207QS1201X	Sleep Medicine (Family Medicine) Physician	54687	MN
2	2083X0100X	Occupational Medicine Physician	54687	MN
3	207Q00000X	Family Medicine Physician	18147	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18147	OTHER	NV	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679899579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEMIAN GITNACHT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 616788
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32861-6788
Country	:	US
Telephone Number	:	407-447-7120
Fax Number	:	407-770-0661

Provider Business Practice Location Address
First Line	:	3129 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	725-220-8457
Fax Number	:	833-749-0355

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	11/29/2021

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