MEDICARE: ABDUSSALAM MOHAMED ALBURKI 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	LL1538	NV
2	208M00000X	Hospitalist Physician	12479	NV

General Provider Information

NPI Number	:	1922077569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDUSSALAM MOHAMED ALBURKI M.D.

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	215
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-671-2355
Fax Number	:	702-382-5388

Provider Business Practice Location Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2329
Country	:	US
Telephone Number	:	702-671-2345
Fax Number	:	702-671-2376

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/03/2007

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