Provider Demographics
NPI:1568505295
Name:MARK C HANDELMAN MD LTD
Entity Type:Organization
Organization Name:MARK C HANDELMAN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-538-7773
Mailing Address - Street 1:2585 BOX CANYON DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0429
Mailing Address - Country:US
Mailing Address - Phone:702-538-7773
Mailing Address - Fax:702-256-9035
Practice Address - Street 1:2585 BOX CANYON DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0429
Practice Address - Country:US
Practice Address - Phone:702-538-7773
Practice Address - Fax:702-256-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6880261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103413OtherMEDICARE ID- UNSPECIFIED
NVV103413OtherMEDICARE ID- UNSPECIFIED