Healthcare Provider Details

I. General information

NPI: 1124462056
Provider Name (Legal Business Name): GRANT MIKI KARNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1998
US

IV. Provider business mailing address

2809 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1998
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9999
  • Fax: 702-946-1343
Mailing address:
  • Phone: 702-476-9999
  • Fax: 702-946-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number16946
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number16946
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: