MEDICARE: QAZI, RIBEIRO, AND SHAH 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	:	1376160291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QAZI, RIBEIRO, AND SHAH PLLC

Provider Business Mailing Address
First Line	:	1925 VILLAGE CENTER CIR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6261
Country	:	US
Telephone Number	:	800-574-8353
Fax Number	:	702-543-7547

Provider Business Practice Location Address
First Line	:	1925 VILLAGE CENTER CIR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6261
Country	:	US
Telephone Number	:	800-574-8353
Fax Number	:	702-543-7547

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MARY CAROL GRAHM
Credential	:
Telephone Number	:	702-326-1127

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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