Provider Demographics
NPI:1023236668
Name:PALM MEDICAL GROUP LLC
Entity type:Organization
Organization Name:PALM MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-696-7256
Mailing Address - Street 1:PO BOX 400475
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0475
Mailing Address - Country:US
Mailing Address - Phone:702-696-7256
Mailing Address - Fax:702-796-7256
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUIT 306
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-696-7256
Practice Address - Fax:702-796-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10001207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H14474Medicare UPIN
H74298Medicare UPIN