Healthcare Provider Details

I. General information

NPI: 1538696307
Provider Name (Legal Business Name): INFECTIOUS DISEASE CONSULTANT OF SOUTHERN NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E DESERT INN RD SUITE 301
LAS VEGAS NV
89169-3242
US

IV. Provider business mailing address

1700 E DESERT INN RD SUITE 301
LAS VEGAS NV
89169-3242
US

V. Phone/Fax

Practice location:
  • Phone: 702-649-8009
  • Fax: 702-492-1728
Mailing address:
  • Phone: 702-649-8009
  • Fax: 702-492-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHIRIN RAHMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-649-8009