Healthcare Provider Details

I. General information

NPI: 1316973647
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES OF SOUTHERN NEVADA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 S MARYLAND PKWY STE 202
LAS VEGAS NV
89109-2313
US

IV. Provider business mailing address

3196 S MARYLAND PKWY STE 202
LAS VEGAS NV
89109-2313
US

V. Phone/Fax

Practice location:
  • Phone: 702-649-8009
  • Fax: 702-649-8049
Mailing address:
  • Phone: 702-649-8009
  • Fax: 702-649-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10067
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number10688
License Number StateNV

VIII. Authorized Official

Name: DR. TANVIR BIN HOSSAIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-649-8009