MEDICARE: SERRIE C LICO 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	25MA10202300	NJ
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD068831L	PA
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35.122143	OH
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	24505	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	:	1790746790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERRIE C LICO MD

Provider Business Mailing Address
First Line	:	801 S RANCHO DR STE E6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3812
Country	:	US
Telephone Number	:	702-240-6482
Fax Number	:

Provider Business Practice Location Address
First Line	:	8530 W SUNSET RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2244
Country	:	US
Telephone Number	:	702-240-6482
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	03/18/2025

Similar Medicare Providers

1710198759 — DR. TIMOTHY THOMAS HAMILTON M.D.
Practice Location Address:

8530 W SUNSET RD STE 110
LAS VEGAS, NV
89113-2244

Practice Phone: 702-240-6482
Practice Fax:

1992859102 — DR. FARHAN SHOAIB AYUBI D.O.
Practice Location Address:

8530 W SUNSET RD STE 110
LAS VEGAS, NV
89113-2244

Practice Phone: 702-240-6482
Practice Fax:

1023218500 — SAN MARTIN SURGERY CENTER LLC
Practice Location Address:

8530 W SUNSET RD , STE 100
LAS VEGAS, NV
89113-2244

Practice Phone: 702-789-5700
Practice Fax: 702-789-5656

1619167855 — MR. MOHI E ALKADRI M.D
Practice Location Address:

8530 W SUNSET RD STE 110
LAS VEGAS, NV
89113-2244

Practice Phone: 702-240-6482
Practice Fax: 702-240-8529

1316583297 — SMI IMAGING LLC
Practice Location Address:

8530 W SUNSET RD STE 120
LAS VEGAS, NV
89113-2244

Practice Phone: 866-614-8555
Practice Fax:

1760466593 — DR. LUIS A TUPAC MD
Practice Location Address:

3006 S MARYLAND PARKWAY , 520
LAS VEGAS, NV
89109-2244

Practice Phone: 702-733-2998
Practice Fax: 702-733-9741

Directions to “ SERRIE C LICO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.