Provider Demographics
NPI:1972839231
Name:IVAN D KARABACHEV MD CHARTERED
Entity Type:Organization
Organization Name:IVAN D KARABACHEV MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KARABACHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-369-3066
Mailing Address - Street 1:3201 S MARYLAND PKWY
Mailing Address - Street 2:#500
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2441
Mailing Address - Country:US
Mailing Address - Phone:702-369-3066
Mailing Address - Fax:702-369-7429
Practice Address - Street 1:3201 S MARYLAND PKWY
Practice Address - Street 2:#500
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2441
Practice Address - Country:US
Practice Address - Phone:702-369-3066
Practice Address - Fax:702-369-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4229207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002809Medicaid
NVV283702740Medicare PIN
NV002002809Medicaid