Provider Demographics
NPI:1326786856
Name:IZKHAKOV MD, PLLC
Entity Type:Organization
Organization Name:IZKHAKOV MD, PLLC
Other - Org Name:ESSENCE ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NERIY
Authorized Official - Middle Name:
Authorized Official - Last Name:IZKHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:702-874-8414
Mailing Address - Street 1:5775 S FORT APACHE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5775 S FORT APACHE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5627
Practice Address - Country:US
Practice Address - Phone:702-874-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366974750OtherNPI