MEDICARE: EJO MANNAPARAMBIL JOHN MD PLLC

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

General Provider Information

NPI Number	:	1225658982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJO MANNAPARAMBIL JOHN MD PLLC

Provider Business Mailing Address
First Line	:	3217 GRAYSON LAKE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3217 GRAYSON LAKE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6614
Country	:	US
Telephone Number	:	773-709-7530
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EJO JOHN
Credential	:
Telephone Number	:	773-709-7530

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	04/23/2020

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