Provider Demographics
NPI:1740268556
Name:MCINTYRE, KENNETH E (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2040 W CHARLESTON BLVD
Mailing Address - Street 2:#601
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2227
Mailing Address - Country:US
Mailing Address - Phone:702-671-2274
Mailing Address - Fax:702-384-7506
Practice Address - Street 1:1707 W CHARLESTON BLVD
Practice Address - Street 2:#160, PATIENT CARE CENTER
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2351
Practice Address - Country:US
Practice Address - Phone:702-671-5150
Practice Address - Fax:702-684-6493
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV103142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018582Medicaid
NVCS11417OtherPHARMACY/CDS
NVCS11417OtherPHARMACY/CDS
NVAM6894427OtherDEA
NV002018582Medicaid