Provider Demographics
NPI:1225364086
Name:SPECTRUM FAMILY MEDICAL
Entity Type:Organization
Organization Name:SPECTRUM FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KARAGIOZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-686-3545
Mailing Address - Street 1:10624 S EASTERN AVE
Mailing Address - Street 2:SUITE A646
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-686-3545
Mailing Address - Fax:
Practice Address - Street 1:1120 ALMOND TREE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3229
Practice Address - Country:US
Practice Address - Phone:702-564-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV476207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
476OtherLICENSE#
NV002018209Medicaid
V40712Medicare PIN
476OtherLICENSE#