MEDICARE: SELWYN A KIDNEY 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	207L00000X	Anesthesiology Physician	6065	NV

General Provider Information

NPI Number	:	1760489264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELWYN A KIDNEY MD

Provider Business Mailing Address
First Line	:	PO BOX 93358
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-3358
Country	:	US
Telephone Number	:	702-487-6510
Fax Number	:	702-405-7960

Provider Business Practice Location Address
First Line	:	3153 E WARM SPRINGS RD
Second Line	:	#300
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-487-6510
Fax Number	:	702-405-7960

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/02/2012

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