MEDICARE: ERNEST M SUSSMAN 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	174400000X	Specialist	6328	NV

General Provider Information

NPI Number	:	1922254887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNEST M SUSSMAN MD

Provider Business Mailing Address
First Line	:	2650 LAKE SAHARA DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3451
Country	:	US
Telephone Number	:	702-293-0176
Fax Number	:	702-293-0938

Provider Business Practice Location Address
First Line	:	2650 LAKE SAHARA DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3451
Country	:	US
Telephone Number	:	702-293-0176
Fax Number	:	702-293-0938

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERNEST M SUSSMAN
Credential	:	M.D.
Telephone Number	:	702-293-0176

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/19/2008

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