Basic Information
| Provider Information | |||||||||
| NPI: | 1861728198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAMMAD | ||||||||
| FirstName: | MIR | ||||||||
| MiddleName: | ALI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 N GIBSON RD | ||||||||
| Address2: | STE 311 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890111708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027768300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10001 S. EASTERN AVENUE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027768300 | ||||||||
| FaxNumber: | 7027768303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2009 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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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 | 207RI0200X | 25MA08395100 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 13506 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.