Provider Demographics
NPI:1407913718
Name:NELLUTLA, AJAY K (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:K
Last Name:NELLUTLA
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1700 E DESERT INN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3207
Mailing Address - Country:US
Mailing Address - Phone:702-649-8009
Mailing Address - Fax:702-649-8049
Practice Address - Street 1:1700 E DESERT INN RD STE 301
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169
Practice Address - Country:US
Practice Address - Phone:702-649-8009
Practice Address - Fax:702-649-8049
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2018-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV10766207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1407913718Medicaid
NVBM069ZMedicare PIN
NV1407913718Medicaid