Provider Demographics
NPI:1598762759
Name:FINE, MILES B (DO)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:B
Last Name:FINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9066
Mailing Address - Country:US
Mailing Address - Phone:702-880-1212
Mailing Address - Fax:702-880-1241
Practice Address - Street 1:1321 S RAINBOW BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9066
Practice Address - Country:US
Practice Address - Phone:702-880-1212
Practice Address - Fax:702-880-1241
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO686207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO686Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NVF71723Medicare UPIN