Provider Demographics
NPI:1609859305
Name:LEELA, GOPALAKRISHNA IYENGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPALAKRISHNA
Middle Name:IYENGAR
Last Name:LEELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3022 S DURANGO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4439
Mailing Address - Country:US
Mailing Address - Phone:702-256-3637
Mailing Address - Fax:702-256-3307
Practice Address - Street 1:3416 N BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7424
Practice Address - Country:US
Practice Address - Phone:702-341-6699
Practice Address - Fax:702-341-6968
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506959Medicaid
NVV101510Medicare PIN
NV100506959Medicaid