Provider Demographics
NPI:1821284720
Name:OKAN MEDICAL GROUP CORP
Entity Type:Organization
Organization Name:OKAN MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-454-7043
Mailing Address - Street 1:3365 E FLAMINGO RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7440
Mailing Address - Country:US
Mailing Address - Phone:702-454-7043
Mailing Address - Fax:
Practice Address - Street 1:3365 E FLAMINGO RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7440
Practice Address - Country:US
Practice Address - Phone:702-454-7043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care