Provider Demographics
NPI:1255459285
Name:BEN KERMANI MD LTD
Entity type:Organization
Organization Name:BEN KERMANI MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KERMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-435-1995
Mailing Address - Street 1:700 E SILVERADO RANCH BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7516
Mailing Address - Country:US
Mailing Address - Phone:702-435-1995
Mailing Address - Fax:702-436-3530
Practice Address - Street 1:700 E SILVERADO RANCH BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7516
Practice Address - Country:US
Practice Address - Phone:702-435-1995
Practice Address - Fax:702-436-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019388Medicaid
NV2019388Medicaid
NVV101763Medicare PIN