Provider Demographics
NPI:1356633424
Name:FRADKIN SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:FRADKIN SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRADKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-538-9284
Mailing Address - Street 1:9811 W CHARLESTON BLVD STE 2-366
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-538-9284
Mailing Address - Fax:702-989-8444
Practice Address - Street 1:9811 W CHARLESTON BLVD STE 2-366
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7528
Practice Address - Country:US
Practice Address - Phone:702-538-9284
Practice Address - Fax:702-989-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty