Provider Demographics
NPI:1720037765
Name:SHERIF W ABDOU MD APC
Entity Type:Organization
Organization Name:SHERIF W ABDOU MD APC
Other - Org Name:SUMMIT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCHUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-932-8582
Mailing Address - Street 1:1776 E WARM SPRINGS RD
Mailing Address - Street 2:200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4676
Mailing Address - Country:US
Mailing Address - Phone:702-932-8547
Mailing Address - Fax:702-932-8586
Practice Address - Street 1:1776 E WARM SPRINGS RD
Practice Address - Street 2:200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4676
Practice Address - Country:US
Practice Address - Phone:702-932-8547
Practice Address - Fax:702-932-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherTAX ID