Provider Demographics
NPI:1861539231
Name:DEB K MUKHOPADHYAY MD PC
Entity type:Organization
Organization Name:DEB K MUKHOPADHYAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUKHOPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-233-0666
Mailing Address - Street 1:653 N TOWN CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0516
Mailing Address - Country:US
Mailing Address - Phone:702-233-0666
Mailing Address - Fax:702-233-8176
Practice Address - Street 1:653 N TOWN CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0516
Practice Address - Country:US
Practice Address - Phone:702-233-0666
Practice Address - Fax:702-233-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1861539231OtherGROUP NPI
NVWCHJGMedicare ID - Type UnspecifiedGROUP
V40556Medicare PIN
H09362Medicare UPIN