Basic Information
| Provider Information | |||||||||
| NPI: | 1144474214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIKMAT N DAGER MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 8264 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900840001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024078241 | ||||||||
| FaxNumber: | 7024921728 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023827760 | ||||||||
| FaxNumber: | 7023827871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2008 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | DAGHER | ||||||||
| AuthorizedOfficialFirstName: | HIKMAT | ||||||||
| AuthorizedOfficialMiddleName: | NICHOLAS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7028751293 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 12664 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RS0012X | 12664 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | 11664 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1124094990 | 05 | NV | MEDICAID |