Provider Demographics
NPI:1316949928
Name:KHRONUSOVA, YEKATERINA ANATOLYEVNA (MD)
Entity type:Individual
Prefix:DR
First Name:YEKATERINA
Middle Name:ANATOLYEVNA
Last Name:KHRONUSOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2466
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1000 S RAINBOW BLVD
Practice Address - Street 2:STE. A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-464-8866
Practice Address - Fax:702-671-6851
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9662207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1316949928Medicaid
NVV100664Medicare PIN
NVBI530ZMedicare PIN
NVBI530X (CQ328A)Medicare PIN
NVBI530W (CQ328B)Medicare PIN