Provider Demographics
NPI:1619443025
Name:HATIM GEMIL MD PLLC
Entity Type:Organization
Organization Name:HATIM GEMIL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HATIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-256-3637
Mailing Address - Street 1:12243 CRYSTAL SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6101
Mailing Address - Country:US
Mailing Address - Phone:702-256-3637
Mailing Address - Fax:702-256-3307
Practice Address - Street 1:2250 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5170
Practice Address - Country:US
Practice Address - Phone:702-256-3637
Practice Address - Fax:702-256-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1366738692Medicaid