Provider Demographics
NPI:1538178561
Name:POOPAT, CHAD (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:POOPAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PALOMINO LANE
Mailing Address - Street 2:STE # 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4894
Mailing Address - Country:US
Mailing Address - Phone:702-759-8600
Mailing Address - Fax:702-384-1815
Practice Address - Street 1:2020 PALOMINO LANE
Practice Address - Street 2:STE # 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4894
Practice Address - Country:US
Practice Address - Phone:702-759-8600
Practice Address - Fax:702-384-1815
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010766792085R0202X
NV147102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262300OtherBLUE CROSS-BLUE CROSS
NVP01199934OtherRR MEDICARE DRS
MI487475910Medicaid
CP076679OtherCHAMPUS-CHAMPUS
NVP01197938OtherRR MEDICARE DESERT RADIOLOGISTS
CP076679OtherCOMMERCIAL-COMMERCIAL NUMBER
NVP01197938OtherRR MEDICARE DESERT RADIOLOGISTS
NVP01199934OtherRR MEDICARE DRS
NVHF639YMedicare PIN
MI487475910Medicaid
NVV106247Medicare PIN