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General NPI Number Information
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NPI Number | 1427593573
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 11035 LAVENDER HILL DR STE 160-435
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City | LAS VEGAS
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State | NV
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Zip | 89135-2955
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Country | US
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Telephone | 702-835-9856
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Fax | 702-629-1620
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Provider Business Mailing Address
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Address Line | 11035 LAVENDER HILL DR STE 160-435
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City | LAS VEGAS
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State | NV
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Zip | 89135-2955
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Country | US
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Telephone | 702-370-3497
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Fax | 702-629-1620
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Authorized Official
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Title or Position | OWNER
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Name | SHIVESH KUMAR
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Credential | MD
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Telephone | 702-370-3497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14464
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License Number State | NV
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