Provider Demographics
NPI:1477741163
Name:STUART ENGEL MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STUART ENGEL MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-379-4753
Mailing Address - Street 1:5380 S RAINBOW BLVD
Mailing Address - Street 2:SUITE300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1877
Mailing Address - Country:US
Mailing Address - Phone:702-379-4753
Mailing Address - Fax:702-889-1969
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:SUITE300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1877
Practice Address - Country:US
Practice Address - Phone:702-379-4753
Practice Address - Fax:702-889-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1497208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1477741163OtherNPI GROUP
NV38035Medicare PIN
NV1477741163OtherNPI GROUP