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701 Shadow Lane #170 Las Vegas NV 89106-4178 | |
| (702) 387-1757 | |
| (702) 387-2006 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 701 Shadow Lane #170, Las Vegas, Nevada |
| Authorized Official Name and Position | Guru Charan (OWNER/MANAGER) |
| Authorized Official Contact | 7024762595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8379 W Sunset Rd Ste 210 Las Vegas NV 89113-2243 Ph: (725) 200-3232 | 701 Shadow Lane #170 Las Vegas NV 89106-4178 Ph: (702) 387-1757 |
| NPI Number | 1942581251 |
|---|---|
| Provider Enumeration Date | 08/31/2011 |
| Last Update Date | 07/06/2022 |
| Certification Date | 07/06/2022 |
| Medicare PECOS PAC ID | 2769653989 |
|---|---|
| Medicare Enrollment ID | O20110920000632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942581251 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | 6062 (Nevada) | Primary |
| Provider Name | Christopher M Milford |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801843396 PECOS PAC ID: 8123000684 Enrollment ID: I20040607001130 |
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