1063630093 NPI number — DR. MICHAEL KEENE MUHLERT M.D.

Table of content: DR. MICHAEL KEENE MUHLERT M.D. (NPI 1063630093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063630093 NPI number — DR. MICHAEL KEENE MUHLERT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUHLERT
Provider First Name:
MICHAEL
Provider Middle Name:
KEENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063630093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 PARK AVE
Provider Second Line Business Mailing Address:
MEMPHIS PHYSICIANS RADIOLOGY PRACTICE GROUP
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-765-3213
Provider Business Mailing Address Fax Number:
901-765-1727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5959 PARK AVE
Provider Second Line Business Practice Location Address:
MPRG
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-765-3213
Provider Business Practice Location Address Fax Number:
901-765-1727
Provider Enumeration Date:
04/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  19865 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 042710 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: E-5336 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 19865 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: E-5336 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 42710 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: 32039 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12112969 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".