Provider Demographics
NPI:1093008674
Name:KWALICK, DONALD SIMON (MD,MPH,FACPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SIMON
Last Name:KWALICK
Suffix:
Gender:M
Credentials:MD,MPH,FACPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 PLAZA DE MONTE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4046
Mailing Address - Country:US
Mailing Address - Phone:702-227-0259
Mailing Address - Fax:702-227-8880
Practice Address - Street 1:3025 PLAZA DE MONTE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4046
Practice Address - Country:US
Practice Address - Phone:702-227-0259
Practice Address - Fax:702-227-8880
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61372083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine