Healthcare Provider Details

I. General information

NPI: 1407028426
Provider Name (Legal Business Name): BISHR HIJAZI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4982 SOUTH RAINBOW BLVD SUITE 100
LAS VEGAS NV
89118-1111
US

IV. Provider business mailing address

4982 SOUTH RAINBOW BLVD SUITE 100
LAS VEGAS NV
89118-1111
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-4100
  • Fax: 702-233-9002
Mailing address:
  • Phone: 702-233-4100
  • Fax: 702-233-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberNV12298
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberC20110322-1075
License Number StateNV

VIII. Authorized Official

Name: SHERI CARMEAN
Title or Position: MANAGER
Credential:
Phone: 702-233-4100