MEDICARE: NERIY IZKHAKOV MD, MPH

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	20052	NV
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	20052	NV

General Provider Information

NPI Number	:	1366974750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERIY IZKHAKOV MD, MPH

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	:	702-874-8414
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	:

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	08/25/2022

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