Provider Demographics
NPI:1275152522
Name:MARTINMD, MAVROIDISMD, DHUDSHIAMD, & FEIKESMD, CARDIOVASCULAR SURGICAL
Entity Type:Organization
Organization Name:MARTINMD, MAVROIDISMD, DHUDSHIAMD, & FEIKESMD, CARDIOVASCULAR SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-719-8952
Mailing Address - Street 1:5320 S RAINBOW BLVD STE 282
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1896
Mailing Address - Country:US
Mailing Address - Phone:702-737-3808
Mailing Address - Fax:702-737-7364
Practice Address - Street 1:7488 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2740
Practice Address - Country:US
Practice Address - Phone:702-737-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503336Medicaid