Provider Demographics
NPI:1699726240
Name:KALLA, SUNIL (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:KALLA
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 1:700 E SILVERADO RANCH BLVD
Mailing Address - Street 2:SUITE #170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7516
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-240-8529
Practice Address - Street 1:2779 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE #240
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4184
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:702-240-8529
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9939207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103055OtherMEDICARE GROUP PTAN
NV20-0562668OtherTAX ID#
V102532OtherRETIRED RAILROAD MEDICARE PIN
NVV106427Medicare PIN
NV20-0562668OtherTAX ID#