=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639248891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANJUM ISMAIL, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10001 S EASTERN AVE SUITE 303
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-3907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-616-0091
-----------------------------------------------------
Fax | 702-616-2329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10001 S EASTERN AVE SUITE 303
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-3907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-616-0091
-----------------------------------------------------
Fax | 702-616-2329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PHYSICIAN
-----------------------------------------------------
Name | ANGELA SHOHO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-454-0290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 9344
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 9575
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------