MEDICARE: BRIAN BEHNAM ONBIRBAK MD

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	7161	NV
2	207R00000X	Internal Medicine Physician	25730	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659331387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BEHNAM ONBIRBAK MD

Provider Business Mailing Address
First Line	:	1995 ALCOVA RIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1551
Country	:	US
Telephone Number	:	702-383-2691
Fax Number	:	702-388-4114

Provider Business Practice Location Address
First Line	:	2300 S RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4506
Country	:	US
Telephone Number	:	702-383-2691
Fax Number	:	402-388-4114

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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