MEDICARE: SURESH K MAKHIJA MD PROF CORP

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	207RN0300X	Nephrology Physician	8875	NV

General Provider Information

NPI Number	:	1932266004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURESH K MAKHIJA MD PROF CORP

Provider Business Mailing Address
First Line	:	2501 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2127
Country	:	US
Telephone Number	:	702-878-3032
Fax Number	:	702-878-3593

Provider Business Practice Location Address
First Line	:	2501 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2127
Country	:	US
Telephone Number	:	702-878-3032
Fax Number	:	702-878-3593

Authorized Official
Title or Position	:	OWNER
Name	:	SURESH KUMAR MAKHIJA
Credential	:	M.D.
Telephone Number	:	702-878-3032

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	08/22/2020

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