Healthcare Provider Details

I. General information

NPI: 1255536322
Provider Name (Legal Business Name): ANANT SONPATKI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 S JONES BLVD STE 500
LAS VEGAS NV
89118-3336
US

IV. Provider business mailing address

PO BOX 777418
HENDERSON NV
89077-7418
US

V. Phone/Fax

Practice location:
  • Phone: 702-631-4700
  • Fax: 702-818-3882
Mailing address:
  • Phone: 702-492-1700
  • Fax: 702-492-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANANT K SONPATKI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-492-1700