Provider Demographics
NPI:1649464975
Name:ADVANCED ADOLESCENT PEDIATRIC GASTROENTEROLOGY
Entity type:Organization
Organization Name:ADVANCED ADOLESCENT PEDIATRIC GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-851-9383
Mailing Address - Street 1:PO BOX 36009
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6009
Mailing Address - Country:US
Mailing Address - Phone:702-851-9383
Mailing Address - Fax:702-851-9380
Practice Address - Street 1:8630 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7260
Practice Address - Country:US
Practice Address - Phone:702-851-9383
Practice Address - Fax:702-851-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV112142080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1649464975Medicaid
NVV105408Medicare PIN