MEDICARE: KIARASH MIRKIA MD PC

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	208600000X	Surgery Physician	12548	NV

General Provider Information

NPI Number	:	1033447362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIARASH MIRKIA MD PC

Provider Business Mailing Address
First Line	:	5875 S RAINBOW BLVD
Second Line	:	STE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	702-889-6292
Fax Number	:	702-979-9055

Provider Business Practice Location Address
First Line	:	5875 S RAINBOW BLVD STE 201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2556
Country	:	US
Telephone Number	:	702-889-6292
Fax Number	:	702-954-4591

Authorized Official
Title or Position	:	OWNER
Name	:	KIARASH MIRKIA
Credential	:	MD
Telephone Number	:	702-496-7500

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	05/15/2017

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