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Organization
A NICKNAM PC
Active
Organization
A NICKNAM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMIR K NICKNAM MD (PRESIDENT)
(702) 733-6622
Entity
Organization
Contact information
Practice address
1712 BEARDEN DR, LAS VEGAS, NV 89106-4107
(702) 733-6622
(702) 382-6622
Mailing address
PO BOX 34717, LAS VEGAS, NV 89133-4717
(702) 733-6622
(702) 382-6622
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11368
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659501302
—
NV
01
—
CP615A
MEDICARE PTAN
NV
Enumeration date
07/15/2009
Last updated
12/31/2013
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