MEDICARE: INDIVIDUALIZED INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	8025	NV

General Provider Information

NPI Number	:	1194120253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIVIDUALIZED INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	8463 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7638
Country	:	US
Telephone Number	:	702-304-0854
Fax Number	:	702-256-2821

Provider Business Practice Location Address
First Line	:	8463 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7638
Country	:	US
Telephone Number	:	702-304-0854
Fax Number	:	702-256-2821

Authorized Official
Title or Position	:	OWNER & PROVIDER
Name	:	SHAMINI K PANIKKAR
Credential	:
Telephone Number	:	702-304-0854

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	01/19/2026

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Practice Location Address:

8463 W LAKE MEAD BLVD
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1740208834 — MR. ROBERT K WHITE M.D.
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Practice Location Address:

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89128-7638

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Practice Location Address:

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Practice Location Address:

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Directions to “INDIVIDUALIZED INTERNAL MEDICINE ” Practice Location

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