Healthcare Provider Details

I. General information

NPI: 1184457970
Provider Name (Legal Business Name): SAMIR MACWAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE A104
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR STE A104
RANCHO MIRAGE CA
92270-4150
US

V. Phone/Fax

Practice location:
  • Phone: 760-895-0639
  • Fax:
Mailing address:
  • Phone: 760-895-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMIR MACWAN
Title or Position: OWNER
Credential: MD
Phone: 760-895-0639