Provider Demographics
NPI:1639248891
Name:ANJUM ISMAIL, MD, PC
Entity Type:Organization
Organization Name:ANJUM ISMAIL, MD, PC
Other - Org Name:SIENA CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-454-0290
Mailing Address - Street 1:10001 S EASTERN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3907
Mailing Address - Country:US
Mailing Address - Phone:702-616-0091
Mailing Address - Fax:702-616-2329
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-616-0091
Practice Address - Fax:702-616-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9575207R00000X
NV9344207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0314OtherRAILROAD MEDICARE
DC0314OtherRAILROAD MEDICARE