Provider Demographics
NPI:1841428026
Name:CAIN, MARCIE (MD)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1397 S LOOP RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4729
Practice Address - Country:US
Practice Address - Phone:775-727-5500
Practice Address - Fax:775-727-5696
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-056430207Q00000X
NV15495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15495OtherSTATE LICENSE
NV1841428026Medicaid
NVV108791Medicare PIN