Healthcare Provider Details

I. General information

NPI: 1558336784
Provider Name (Legal Business Name): FEROZAN MALAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N TOWN CENTER DR STE 100
LAS VEGAS NV
89144-6308
US

IV. Provider business mailing address

1180 N TOWN CENTER DR STE 100
LAS VEGAS NV
89144-6308
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-2060
  • Fax: 702-605-2892
Mailing address:
  • Phone: 702-202-2060
  • Fax: 702-605-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number11605
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11605
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: