Basic Information
Provider Information
NPI: 1710956768
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STREBEL
FirstName: KORD
MiddleName: THOMAS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8906 SPANISH RIDGE AVE STE 202
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891481319
CountryCode: US
TelephoneNumber: 7023303102
FaxNumber: 7029124994
Practice Location
Address1: 1950 PINTO LN
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891064017
CountryCode: US
TelephoneNumber: 7024382229
FaxNumber: 7023850982
Other Information
ProviderEnumerationDate: 03/14/2006
LastUpdateDate: 11/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X11468NVY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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