Provider Demographics
NPI:1629356274
Name:CHAMIAN MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:CHAMIAN MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-982-6402
Mailing Address - Street 1:7325 S PECOS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3768
Mailing Address - Country:US
Mailing Address - Phone:702-982-6402
Mailing Address - Fax:702-202-0674
Practice Address - Street 1:7325 S PECOS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3768
Practice Address - Country:US
Practice Address - Phone:702-982-6402
Practice Address - Fax:702-202-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376533059Medicaid