MEDICARE: POUPAK ZIAEI MD LTD

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	12525	NV

General Provider Information

NPI Number	:	1831330885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POUPAK ZIAEI MD LTD

Provider Business Mailing Address
First Line	:	5052 S JONES BLVD
Second Line	:	SUITE 135
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-0538
Country	:	US
Telephone Number	:	702-902-2400
Fax Number	:	702-902-2401

Provider Business Practice Location Address
First Line	:	5052 S JONES BLVD
Second Line	:	SUITE 135
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-0538
Country	:	US
Telephone Number	:	702-902-2400
Fax Number	:	702-902-2401

Authorized Official
Title or Position	:	ACCTS. MGR
Name	:	MRS. LORI ANN LABRECQUE
Credential	:
Telephone Number	:	702-453-3799

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	09/25/2014

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