=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932266004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURESH K MAKHIJA MD PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 W CHARLESTON BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-878-3032
-----------------------------------------------------
Fax | 702-878-3593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 W CHARLESTON BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-878-3032
-----------------------------------------------------
Fax | 702-878-3593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SURESH KUMAR MAKHIJA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 702-878-3032
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 8875
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------