MEDICARE: IZKHAKOV 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366974750	OTHER		NPI

General Provider Information

NPI Number	:	1326786856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IZKHAKOV MD, PLLC

Provider Business Mailing Address
First Line	:	5775 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5627
Country	:	US
Telephone Number	:	702-874-8414
Fax Number	:	702-637-4124

Authorized Official
Title or Position	:	MANAGER
Name	:	NERIY IZKHAKOV
Credential	:	MD, MPH
Telephone Number	:	702-874-8414

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	03/17/2025

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