Provider Demographics
NPI:1063497519
Name:MEMPHIS INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:MEMPHIS INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:PELZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-684-1322
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 900B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-684-1322
Mailing Address - Fax:901-682-6368
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 900B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-684-1322
Practice Address - Fax:901-682-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3807925Medicare ID - Type Unspecified