Provider Demographics
NPI:1245401793
Name:BADRUNNISA HANIF MD PC
Entity Type:Organization
Organization Name:BADRUNNISA HANIF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BADRUNNISA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HANIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-214-9741
Mailing Address - Street 1:PO BOX 400937
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0937
Mailing Address - Country:US
Mailing Address - Phone:702-791-1222
Mailing Address - Fax:702-735-9074
Practice Address - Street 1:5495 S RAINBOW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1872
Practice Address - Country:US
Practice Address - Phone:702-791-1222
Practice Address - Fax:702-735-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105529Medicare PIN