MEDICARE: PRASAD-LEELA LLC

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	11458	NV

General Provider Information

NPI Number	:	1629187885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRASAD-LEELA LLC

Provider Business Mailing Address
First Line	:	3022 S DURANGO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4440
Country	:	US
Telephone Number	:	702-341-6699
Fax Number	:	702-341-6968

Provider Business Practice Location Address
First Line	:	3416 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7424
Country	:	US
Telephone Number	:	702-341-6699
Fax Number	:	702-341-6968

Authorized Official
Title or Position	:	OWNER
Name	:	GOPALAKRISHNA IYENGAR LEELA
Credential	:	MD
Telephone Number	:	702-341-6699

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/14/2023

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Directions to “PRASAD-LEELA LLC ” Practice Location

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