MEDICARE: DR. STEVEN JULIUS LISSAU 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	207Q00000X	Family Medicine Physician	6072	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC8251	OTHER	NV	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1841215266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN JULIUS LISSAU MD

Provider Business Mailing Address
First Line	:	5240 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2306
Country	:	US
Telephone Number	:	702-480-4006
Fax Number	:	702-736-8889

Provider Business Practice Location Address
First Line	:	5240 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2306
Country	:	US
Telephone Number	:	702-480-4006
Fax Number	:	702-736-8889

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/13/2007

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