Provider Demographics
NPI:1376521906
Name:RAZZAQ, IRFANA KAUSAR (MD)
Entity Type:Individual
Prefix:
First Name:IRFANA
Middle Name:KAUSAR
Last Name:RAZZAQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2040 W CHARLESTON BLVD
Mailing Address - Street 2:300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2227
Mailing Address - Country:US
Mailing Address - Phone:702-671-2355
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:1701 W CHARLESTON BLVD
Practice Address - Street 2:215
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2325
Practice Address - Country:US
Practice Address - Phone:702-671-2355
Practice Address - Fax:702-382-5388
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11469207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506795Medicaid
NV100506794Medicaid
NV100500484 GROUPMedicaid
NVI43910Medicare UPIN
NVWQBHVMedicare ID - Type UnspecifiedGROUP MEDICARE
NV100506795Medicaid