Provider Demographics
NPI:1457774986
Name:AMDE PLLC
Entity Type:Organization
Organization Name:AMDE PLLC
Other - Org Name:DESERT KIDNEY AND HYPERTENSION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-882-1980
Mailing Address - Street 1:2610 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2869
Mailing Address - Country:US
Mailing Address - Phone:702-407-8241
Mailing Address - Fax:702-492-1728
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2869
Practice Address - Country:US
Practice Address - Phone:702-407-8241
Practice Address - Fax:702-492-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14455207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376710277Medicaid
NVGW323ZMedicare PIN