Healthcare Provider Details

I. General information

NPI: 1538422183
Provider Name (Legal Business Name): RAJIV PRADEEP AMESUR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89012-3516
US

IV. Provider business mailing address

3459 SAINT ROSE PKWY STE 120-481
HENDERSON NV
89052-4601
US

V. Phone/Fax

Practice location:
  • Phone: 702-781-4800
  • Fax: 702-664-6755
Mailing address:
  • Phone: 702-781-4800
  • Fax: 702-664-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1939
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDO1939
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDO1939
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: