Healthcare Provider Details

I. General information

NPI: 1447449269
Provider Name (Legal Business Name): TAREQ JAMIL MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR SUITE #202
LAS VEGAS NV
89144-0514
US

IV. Provider business mailing address

2809 CRYSTAL BEACH DR
LAS VEGAS NV
89128-6908
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-6694
  • Fax: 702-233-0485
Mailing address:
  • Phone: 702-477-5874
  • Fax: 702-430-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number10292
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10292
License Number StateNV

VIII. Authorized Official

Name: TAREQ JAMIL
Title or Position: PRESEDENT
Credential: MD
Phone: 702-477-5874