Provider Demographics
NPI:1346465283
Name:CONDOLEON SURGERY LTD.
Entity Type:Organization
Organization Name:CONDOLEON SURGERY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDOELON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-562-0801
Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-562-0801
Mailing Address - Fax:702-562-0802
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 630
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-562-0801
Practice Address - Fax:702-562-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61933Medicare UPIN