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Individual

DR. PREM K KITTUSAMY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
401 N BUFFALO DR, SUITE 100, LAS VEGAS, NV 89145-0310
(702) 489-9000
(702) 489-9001
Mailing address
401 N BUFFALO DR STE 100, LAS VEGAS, NV 89145-0397
(702) 489-9000
(702) 489-9001

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
10827
NV
207RC0000X
Cardiovascular Disease Physician
MD069834L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100503391
NV
01
BM4472
MEDICARE ID TYPE
NV
Enumeration date
07/31/2006
Last updated
02/07/2018
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