Provider Demographics
NPI:1053485409
Name:CAESARS PALACE MEDICAL CLINIC
Entity Type:Organization
Organization Name:CAESARS PALACE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-731-7372
Mailing Address - Street 1:3570 LAS VEGAS BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-8924
Mailing Address - Country:US
Mailing Address - Phone:702-731-7372
Mailing Address - Fax:702-735-2272
Practice Address - Street 1:3570 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-8924
Practice Address - Country:US
Practice Address - Phone:702-731-7372
Practice Address - Fax:702-735-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV096028Medicare UPIN