Provider Demographics
NPI:1609809607
Name:MAHAJAN, RENU S (MD)
Entity Type:Individual
Prefix:DR
First Name:RENU
Middle Name:S
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8970 W TROPICANA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8137
Mailing Address - Country:US
Mailing Address - Phone:702-473-5333
Mailing Address - Fax:702-473-5444
Practice Address - Street 1:8970 W TROPICANA AVE STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8137
Practice Address - Country:US
Practice Address - Phone:702-473-5333
Practice Address - Fax:702-473-5444
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV14636207R00000X
UT50115531205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064166Medicare PIN