Provider Demographics
NPI:1679630743
Name:MAKHIJA, SURESH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:KUMAR
Last Name:MAKHIJA
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 1:2820 W CHARLESTON BLVD STE 33
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1934
Mailing Address - Country:US
Mailing Address - Phone:702-880-1558
Mailing Address - Fax:702-870-6821
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 33
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1934
Practice Address - Country:US
Practice Address - Phone:702-880-1558
Practice Address - Fax:702-870-6821
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8875207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018161Medicaid
NV40196Medicare ID - Type Unspecified
NV002018161Medicaid