Provider Demographics
NPI:1629573555
Name:RAFEEQI, TALHA ADIL (MD)
Entity Type:Individual
Prefix:
First Name:TALHA
Middle Name:ADIL
Last Name:RAFEEQI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 S RAINBOW BLVD
Mailing Address - Street 2:GME SUITE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-853-3561
Mailing Address - Fax:
Practice Address - Street 1:6655 S CIMARRON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2181
Practice Address - Country:US
Practice Address - Phone:702-853-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000000000000208600000X
NVLL3253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery