Basic Information
| Provider Information | |||||||||
| NPI: | 1225215684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEERAPANENI | ||||||||
| FirstName: | VIVEK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S RANCHO DR | ||||||||
| Address2: | STE. 12 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S RANCHO DR | ||||||||
| Address2: | STE. 12 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 14395 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1225215684 | 05 | NV | MEDICAID |