MEDICARE: DR. KENNETH ERVINE FATKIN DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	1008	NV

General Provider Information

NPI Number	:	1922238195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ERVINE FATKIN DPM

Provider Business Mailing Address
First Line	:	1485 W WARM SPRINGS RD STE 102
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-7632
Country	:	US
Telephone Number	:	702-435-7987
Fax Number	:	702-435-7616

Provider Business Practice Location Address
First Line	:	1485 W WARM SPRINGS RD STE 102
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-7632
Country	:	US
Telephone Number	:	702-435-7987
Fax Number	:	702-435-7616

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	08/03/2022

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