Provider Demographics
NPI: | 1417098567 |
---|---|
Name: | CREMONINI, FILIPPO (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | FILIPPO |
Middle Name: | |
Last Name: | CREMONINI |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 7315 S. PECOS ROAD |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89120 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-982-7240 |
Mailing Address - Fax: | 702-586-7506 |
Practice Address - Street 1: | 3910 S MARYLAND PKWY |
Practice Address - Street 2: | SUITE 9B |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89119-7570 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-982-7240 |
Practice Address - Fax: | 702-586-7506 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-10 |
Last Update Date: | 2016-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 49957 | 207R00000X |
MA | 246157 | 207RG0100X |
NV | 14135 | 207RG0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 161960000 | Medicaid | |
MN | 161960000 | Medicaid |