MEDICARE: ABOLGHASEM JAVAHERIAN M.D.

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	25426	NV
2	207R00000X	Internal Medicine Physician	34839	WI

General Provider Information

NPI Number	:	1639116023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABOLGHASEM JAVAHERIAN M.D.

Provider Business Mailing Address
First Line	:	8672 INDIGO SPRING RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7557
Country	:	US
Telephone Number	:	715-379-2883
Fax Number	:

Provider Business Practice Location Address
First Line	:	8672 INDIGO SPRING RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7557
Country	:	US
Telephone Number	:	715-379-2883
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/23/2025

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