Provider Demographics
NPI:1154457521
Name:SIKISAM ALI MAGOYAG PC
Entity Type:Organization
Organization Name:SIKISAM ALI MAGOYAG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIKISAM
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MAGOYAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-240-5051
Mailing Address - Street 1:PO BOX 371576
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1576
Mailing Address - Country:US
Mailing Address - Phone:702-240-5051
Mailing Address - Fax:702-240-5053
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-240-5051
Practice Address - Fax:702-240-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH49175Medicare UPIN
NVV103178Medicare PIN