Provider Demographics
NPI:1013302884
Name:NARASIMHAN, VIVEK B (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:B
Last Name:NARASIMHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1840 MESQUITE AVE OFC PE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5771
Mailing Address - Country:US
Mailing Address - Phone:928-208-4598
Mailing Address - Fax:623-227-2000
Practice Address - Street 1:1840 MESQUITE AVE OFC PE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-208-4598
Practice Address - Fax:623-227-2000
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18068207R00000X
AZ62666207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program