Provider Demographics
NPI:1366704900
Name:TATARI, ATIF A (DO)
Entity type:Individual
Prefix:MR
First Name:ATIF
Middle Name:A
Last Name:TATARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHADOW LN STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4158
Mailing Address - Country:US
Mailing Address - Phone:702-384-0022
Mailing Address - Fax:702-384-0529
Practice Address - Street 1:5380 S RAINBOW BLVD STE 226
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1879
Practice Address - Country:US
Practice Address - Phone:702-384-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2588207RC0000X, 207RI0011X
KY04031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250018658Medicaid