Individual
SERRIE C LICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8530 W SUNSET RD STE 110, LAS VEGAS, NV 89113-2244
(702) 240-6482
Mailing address
801 S RANCHO DR STE E6, LAS VEGAS, NV 89106-3812
(702) 240-6482
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
24505
NV
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
25MA10202300
NJ
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35.122143
OH
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
MD068831L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03112934
—
NY
Enumeration date
03/29/2006
Last updated
03/18/2025
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