MEDICARE: MR. ISHAN K ACHARYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	18007	NV

General Provider Information

NPI Number	:	1023489671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISHAN K ACHARYA MD

Provider Business Mailing Address
First Line	:	5870 HIATUS RD
Second Line	:	REGIONAL ADMIN OFFICE - PE WEST
City	:	TAMARAC
State	:	FL
Zip	:	33321-6424
Country	:	US
Telephone Number	:	888-447-2362
Fax Number	:	865-560-7110

Provider Business Practice Location Address
First Line	:	SUNRISE HOSPITAL AND MEDICAL CENTER
Second Line	:	3186 S MARYLAND PKWY
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2306
Country	:	US
Telephone Number	:	702-731-8211
Fax Number	:	702-731-8201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	11/07/2018

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