=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912334988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAYEF T. RESK MD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2013
-----------------------------------------------------
Last Update Date | 06/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3003 HIGHWAY 95 SUITE 35
-----------------------------------------------------
City | BULLHEAD CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86442-7896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-704-0400
-----------------------------------------------------
Fax | 928-704-0400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 HIGHWAY 95 SUITE 35
-----------------------------------------------------
City | BULLHEAD CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86442-7896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-704-0400
-----------------------------------------------------
Fax | 928-704-0400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KAMILIA BANOUB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-704-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25571
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------