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NPI Code Detail

MEDICARE: MIRELA MALEVANOV MD PC

MEDICARE: MIRELA MALEVANOV MD PC
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
1207R00000XInternal Medicine Physician
2207RP1001XPulmonary Disease Physician
3207RC0200XCritical Care Medicine (Internal Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V102802OTHERNVPTAN

General Provider Information

NPI Number : 1952402810
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIRELA MALEVANOV MD PC
Provider Business Mailing Address
First Line : 8275 S EASTERN AVE STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2545
Country : US
Telephone Number : 702-483-6200
Fax Number : 702-458-6117
Provider Business Practice Location Address
First Line : 8275 S EASTERN AVE STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2545
Country : US
Telephone Number : 702-483-6200
Fax Number : 702-458-6117
Authorized Official
Title or Position : PRESIDENT
Name : MIRELA C MALEVANOV
Credential : MD
Telephone Number : 702-483-6200
Provider Enumeration Date : 09/25/2006
Last Update Date : 01/07/2019

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