MEDICARE: DR. MARK VANDENBOSCH 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	207L00000X	Anesthesiology Physician	ME64003	FL
2	207L00000X	Anesthesiology Physician	14668	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	:	1871686733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK VANDENBOSCH M.D.

Provider Business Mailing Address
First Line	:	2844 EVENING ROCK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1631
Country	:	US
Telephone Number	:	321-698-6853
Fax Number	:	702-818-3452

Provider Business Practice Location Address
First Line	:	1330 S VALLEY VIEW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1865
Country	:	US
Telephone Number	:	702-675-4600
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/17/2021

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