Provider Demographics
NPI:1013066125
Name:SEVERINO, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:SEVERINO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5320 S. RAINBOW BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1986
Mailing Address - Country:US
Mailing Address - Phone:702-794-0073
Mailing Address - Fax:702-794-0042
Practice Address - Street 1:5320 S. RAINBOW BLVD
Practice Address - Street 2:STE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1986
Practice Address - Country:US
Practice Address - Phone:702-794-0073
Practice Address - Fax:702-794-0042
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-04-28
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Provider Licenses
StateLicense IDTaxonomies
WI44505207RE0101X
NV7453207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34243800Medicaid
WI34243800Medicaid