Provider Demographics
NPI:1134105547
Name:KHAMAMKAR, RAJEEV S (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:S
Last Name:KHAMAMKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 VILLAGE CENTER CIR
Mailing Address - Street 2:SUITE #3-777
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6238
Mailing Address - Country:US
Mailing Address - Phone:702-340-2700
Mailing Address - Fax:702-242-9505
Practice Address - Street 1:10345 HOWLING COYOTE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1119
Practice Address - Country:US
Practice Address - Phone:702-340-2700
Practice Address - Fax:702-242-9505
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8597207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG20095Medicare UPIN