Provider Demographics
NPI:1134506934
Name:MARROUSH, TARIQ S (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:S
Last Name:MARROUSH
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 1:3150 N TENAYA WAY
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0463
Mailing Address - Country:US
Mailing Address - Phone:702-233-1000
Mailing Address - Fax:702-233-1001
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 460
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0463
Practice Address - Country:US
Practice Address - Phone:702-233-1000
Practice Address - Fax:702-233-1001
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107062207R00000X
NV22215246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine