MEDICARE: BEN KERMANI, M.D., 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

General Provider Information

NPI Number	:	1922126952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEN KERMANI, M.D., LTD

Provider Business Mailing Address
First Line	:	291 N PECOS RD
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1918
Country	:	US
Telephone Number	:	702-435-1995
Fax Number	:	702-436-3530

Provider Business Practice Location Address
First Line	:	4670 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6310
Country	:	US
Telephone Number	:	702-531-3546
Fax Number	:	702-531-3582

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BEHZAD KERMANI
Credential	:	M.D.
Telephone Number	:	702-435-1995

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	11/23/2009

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