Provider Demographics
NPI:1447449269
Name:TAREQ JAMIL MD, PC
Entity type:Organization
Organization Name:TAREQ JAMIL MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-477-5874
Mailing Address - Street 1:2809 CRYSTAL BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6908
Mailing Address - Country:US
Mailing Address - Phone:702-477-5874
Mailing Address - Fax:702-430-8419
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE #202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-233-6694
Practice Address - Fax:702-233-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10292207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH71183Medicare UPIN