Provider Demographics
NPI:1184819203
Name:WADHWA, MUKESH NARAIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:NARAIN
Last Name:WADHWA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 N STANTON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2511
Mailing Address - Country:US
Mailing Address - Phone:702-258-1322
Mailing Address - Fax:702-258-1322
Practice Address - Street 1:2450 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2179
Practice Address - Country:US
Practice Address - Phone:702-877-8661
Practice Address - Fax:702-258-1322
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4393207L00000X
NVDO1935207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184819203Medicaid
NVV114869Medicare PIN
NV1184819203Medicaid