Provider Demographics
NPI:1417946773
Name:EMANUEL, CARLOS C (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:C
Last Name:EMANUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:SUITE #240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4158
Mailing Address - Country:US
Mailing Address - Phone:702-384-0022
Mailing Address - Fax:702-384-0529
Practice Address - Street 1:700 SHADOW LN
Practice Address - Street 2:SUITE #240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4158
Practice Address - Country:US
Practice Address - Phone:702-384-0022
Practice Address - Fax:702-384-0529
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9747207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018769Medicaid
NV20-18769Medicaid
35234Medicare PIN
NVG37112Medicare UPIN
NV2018769Medicaid