MEDICARE: DR. KERALAPURA PADMINI SUBRAMANYAM M.D.

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	207Q00000X	Family Medicine Physician	NV6696	NV

General Provider Information

NPI Number	:	1225096209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERALAPURA PADMINI SUBRAMANYAM M.D.

Provider Business Mailing Address
First Line	:	2517 SUN REEF RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6880
Country	:	US
Telephone Number	:	702-363-5392
Fax Number	:	702-233-5860

Provider Business Practice Location Address
First Line	:	4331 N RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3407
Country	:	US
Telephone Number	:	702-383-3800
Fax Number	:	702-395-9511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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