MEDICARE: DR. GOPALAKRISHNA IYENGAR LEELA 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	11458	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	:	1609859305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOPALAKRISHNA IYENGAR LEELA MD

Provider Business Mailing Address
First Line	:	3022 S DURANGO DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4439
Country	:	US
Telephone Number	:	702-256-3637
Fax Number	:	702-256-3307

Provider Business Practice Location Address
First Line	:	3416 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7424
Country	:	US
Telephone Number	:	702-341-6699
Fax Number	:	702-341-6968

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	09/14/2023

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