Provider Demographics
NPI:1023489671
Name:ACHARYA, ISHAN K (MD)
Entity type:Individual
Prefix:MR
First Name:ISHAN
Middle Name:K
Last Name:ACHARYA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5870 HIATUS RD
Mailing Address - Street 2:REGIONAL ADMIN OFFICE - PE WEST
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6424
Mailing Address - Country:US
Mailing Address - Phone:888-447-2362
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:SUNRISE HOSPITAL AND MEDICAL CENTER
Practice Address - Street 2:3186 S MARYLAND PKWY
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2306
Practice Address - Country:US
Practice Address - Phone:702-731-8211
Practice Address - Fax:702-731-8201
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2018-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NV18007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program