MEDICARE: NIUTON SEIGO KOIDE 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	207RC0000X	Cardiovascular Disease Physician	11761	NV
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	11761	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GB910Y-GB910Z	OTHER	NV	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1821067059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIUTON SEIGO KOIDE MD

Provider Business Mailing Address
First Line	:	PO BOX 100744
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 N TENAYA WAY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0642
Country	:	US
Telephone Number	:	702-962-2200
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	03/30/2023

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Directions to “ NIUTON SEIGO KOIDE MD” Practice Location

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