Healthcare Provider Details

I. General information

NPI: 1578012670
Provider Name (Legal Business Name): OGANES SHILGEVORKYAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 S DURANGO DR STE 100
LAS VEGAS NV
89117-4440
US

IV. Provider business mailing address

500 N RAINBOW BLVD SUITE 300
LAS VEGAS NV
89107-1082
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-3637
  • Fax: 877-991-2948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16480
License Number StateNV

VIII. Authorized Official

Name: DR. OGANES HOVIK SHILGEVORKYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-621-8142