Provider Demographics
NPI:1194120253
Name:INDIVIDUALIZED INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:INDIVIDUALIZED INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMINI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PANIKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-304-0854
Mailing Address - Street 1:8463 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7638
Mailing Address - Country:US
Mailing Address - Phone:702-304-0854
Mailing Address - Fax:702-256-2821
Practice Address - Street 1:8463 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7638
Practice Address - Country:US
Practice Address - Phone:702-304-0854
Practice Address - Fax:702-256-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty