MEDICARE: INTERNAL MEDICINE CLINIC BANERJI LTD

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	261QP2300X	Primary Care Clinic/Center	9544	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD5081	OTHER	NV	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1851403646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE CLINIC BANERJI LTD

Provider Business Mailing Address
First Line	:	5731 SOUTH FORT APACHE ROAD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89148
Country	:	US
Telephone Number	:	702-740-5311
Fax Number	:	702-740-5310

Provider Business Practice Location Address
First Line	:	5731 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5620
Country	:	US
Telephone Number	:	702-740-5311
Fax Number	:	702-740-5310

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BASHAB BANERJI
Credential	:	MD
Telephone Number	:	702-740-5311

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/03/2019

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