Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 7063 | NV |
NPI | 1023099132 |
---|---|
Provider Name | Marwan A Takieddine |
First Address | Las Vegas, NV 89169-1778 |
Second Address | Las Vegas, NV 89128-9034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002019634 | (05) | NV |
1023099132 | (05) | NV |
347064 | (05) | AZ |
A85865 | (02) |