MEDICARE: RANCHO INTERNAL MEDICINE GROUP PC

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	NV9751	NV

General Provider Information

NPI Number	:	1609063627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO INTERNAL MEDICINE GROUP PC

Provider Business Mailing Address
First Line	:	7010 SMOKE RANCH RD
Second Line	:	120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3123
Country	:	US
Telephone Number	:	702-477-7044
Fax Number	:	702-388-1664

Provider Business Practice Location Address
First Line	:	7010 SMOKE RANCH RD
Second Line	:	120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3123
Country	:	US
Telephone Number	:	702-477-7044
Fax Number	:	702-388-1664

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANIT DUA
Credential	:	M.D.
Telephone Number	:	702-477-7044

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/07/2015

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