Provider Demographics
NPI:1356367734
Name:MUTHAIAH, RAMANATHAN (MD)
Entity type:Individual
Prefix:
First Name:RAMANATHAN
Middle Name:
Last Name:MUTHAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 N RAINBOW BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1689
Mailing Address - Country:US
Mailing Address - Phone:702-220-8001
Mailing Address - Fax:702-395-4500
Practice Address - Street 1:5061 N RAINBOW BLVD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1689
Practice Address - Country:US
Practice Address - Phone:702-220-8001
Practice Address - Fax:702-395-4500
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101338Medicare PIN