MEDICARE: FARRUKH IMTIAZ 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	207R00000X	Internal Medicine Physician	9523	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063404663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRUKH IMTIAZ MD

Provider Business Mailing Address
First Line	:	3650 S EASTERN AVE
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3379
Country	:	US
Telephone Number	:	702-933-6768
Fax Number	:	702-933-6770

Provider Business Practice Location Address
First Line	:	3650 S EASTERN AVE
Second Line	:	STE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-933-6768
Fax Number	:	702-933-6770

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	02/06/2018

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