Healthcare Provider Details

I. General information

NPI: 1316108202
Provider Name (Legal Business Name): ANUP PANDURANGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7751 W FLAMINGO RD A100
LAS VEGAS NV
89147-5401
US

IV. Provider business mailing address

7751 W FLAMINGO RD A100
LAS VEGAS NV
89147-5401
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-6555
  • Fax: 702-804-1222
Mailing address:
  • Phone: 702-450-8485
  • Fax: 702-804-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number22849
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD161408
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number22849
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: