Provider Demographics
NPI:1124287339
Name:SHAMLOO, BEHROOZ KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:BEHROOZ
Middle Name:KEVIN
Last Name:SHAMLOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7391 W CHARLESTON BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1577
Mailing Address - Country:US
Mailing Address - Phone:702-304-2144
Mailing Address - Fax:702-304-2147
Practice Address - Street 1:3022 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4440
Practice Address - Country:US
Practice Address - Phone:702-256-3637
Practice Address - Fax:702-256-3307
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13639207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5153188OtherCIGNA
NV9285669OtherAETNA
NV9285669OtherAETNA