Individual
SUSMITA BHOGINENI-THAKORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
650 N NELLIS BLVD, LAS VEGAS, NV 89110
(702) 459-7424
(702) 459-0320
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 560-2879
(702) 560-2928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11306
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506075
—
NV
05
—
100506076
—
NV
Enumeration date
01/23/2006
Last updated
03/18/2010
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