Healthcare Provider Details

I. General information

NPI: 1922077569
Provider Name (Legal Business Name): ABDUSSALAM MOHAMED ALBURKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD 215
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2345
  • Fax: 702-671-2376
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL1538
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12479
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: