Provider Demographics
NPI:1598793549
Name:MARTINMD, MAVROIDISMD, DHUDSHIAMD, & FEIKESMD, CARDIOVASCULAR SURGICAL
Entity Type:Organization
Organization Name:MARTINMD, MAVROIDISMD, DHUDSHIAMD, & FEIKESMD, CARDIOVASCULAR SURGICAL
Other - Org Name:CARDIOVASCULAR SURGERY OF SOUTHERN NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-719-8934
Mailing Address - Street 1:5320 SOUTH RAINBOW BLVD
Mailing Address - Street 2:#282
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-737-3808
Mailing Address - Fax:702-737-7364
Practice Address - Street 1:5320 SOUTH RAINBOW BLVD
Practice Address - Street 2:#282
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-737-3808
Practice Address - Fax:702-737-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503336Medicaid
NVWCKDDMedicare PIN