Provider Demographics
NPI:1629187885
Name:PRASAD-LEELA LLC
Entity Type:Organization
Organization Name:PRASAD-LEELA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOPALAKRISHNA
Authorized Official - Middle Name:IYENGAR
Authorized Official - Last Name:LEELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-341-6699
Mailing Address - Street 1:3022 S DURANGO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4440
Mailing Address - Country:US
Mailing Address - Phone:702-341-6699
Mailing Address - Fax:702-341-6968
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101509Medicare PIN