Healthcare Provider Details

I. General information

NPI: 1619332962
Provider Name (Legal Business Name): KARIM SIRSY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 S EASTERN AVE STE 100
HENDERSON NV
89052-4971
US

IV. Provider business mailing address

10950 S EASTERN AVE STE 100
HENDERSON NV
89052-4971
US

V. Phone/Fax

Practice location:
  • Phone: 702-614-2192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2173
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13738
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO2173
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: