Provider Demographics
NPI:1952402810
Name:MIRELA MALEVANOV MD PC
Entity Type:Organization
Organization Name:MIRELA MALEVANOV MD PC
Other - Org Name:PULMONARY PHYSICIANS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALEVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-483-6200
Mailing Address - Street 1:8275 S EASTERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2545
Mailing Address - Country:US
Mailing Address - Phone:702-483-6200
Mailing Address - Fax:702-458-6117
Practice Address - Street 1:8275 S EASTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2545
Practice Address - Country:US
Practice Address - Phone:702-483-6200
Practice Address - Fax:702-458-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102802OtherPTAN