Provider Demographics
NPI:1154808210
Name:DEBIPARSHAD PROFESSIONAL SERVICES PLLC
Entity type:Organization
Organization Name:DEBIPARSHAD PROFESSIONAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEBIPARSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-693-8792
Mailing Address - Street 1:870 SEVEN HILLS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4378
Mailing Address - Country:US
Mailing Address - Phone:702-678-4658
Mailing Address - Fax:469-453-3374
Practice Address - Street 1:870 SEVEN HILLS DR STE 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4378
Practice Address - Country:US
Practice Address - Phone:702-678-4658
Practice Address - Fax:469-453-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15997204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15997OtherMEDICAL LIC