Provider Demographics
NPI:1043262538
Name:ABUTINEH, MOHAMMAD I (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:I
Last Name:ABUTINEH
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0338
Mailing Address - Country:US
Mailing Address - Phone:901-351-2120
Mailing Address - Fax:901-761-4145
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:SUITE 1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-351-2120
Practice Address - Fax:901-761-4145
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29209208M00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3812969Medicaid
TN3812969Medicaid
TN3812969Medicare ID - Type Unspecified