Provider Demographics
NPI:1124170493
Name:R MUTHAIAH MD PC
Entity type:Organization
Organization Name:R MUTHAIAH MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMANATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-220-8001
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101337Medicare PIN