| Individualized Internal Medicine Llc | |
|
8463 W Lake Mead Blvd Las Vegas NV 89128-7638 | |
| (702) 304-0854 | |
| (702) 256-2821 |
| Full Name | Individualized Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8463 W Lake Mead Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Shamini K Panikkar (OWNER AND PHYSICIAN) |
| Authorized Official Contact | 7023040854 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Individualized Internal Medicine Llc 8463 W Lake Mead Blvd Las Vegas NV 89128-7638 Ph: (702) 304-0854 | Individualized Internal Medicine Llc 8463 W Lake Mead Blvd Las Vegas NV 89128-7638 Ph: (702) 304-0854 |
| NPI Number | 1194120253 |
|---|---|
| Provider Enumeration Date | 10/30/2014 |
| Last Update Date | 10/30/2014 |
| Medicare PECOS PAC ID | 0446573927 |
|---|---|
| Medicare Enrollment ID | O20150123001998 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194120253 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 8025 (Nevada) | Primary |
| Provider Name | Shamini K Panikkar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508898768 PECOS PAC ID: 5294723730 Enrollment ID: I20120210000450 |
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