Provider Demographics
NPI:1104833326
Name:QURESHI, MOHAMMAD NAUMAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:NAUMAN
Last Name:QURESHI
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 1000
Mailing Address - Street 2:DEPT 913
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0913
Mailing Address - Country:US
Mailing Address - Phone:901-266-1080
Mailing Address - Fax:901-266-1158
Practice Address - Street 1:290 S WALNUT BEND
Practice Address - Street 2:STE 1
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7280
Practice Address - Country:US
Practice Address - Phone:901-266-1080
Practice Address - Fax:901-266-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000037276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723254Medicaid
TNH92644Medicare UPIN
TNH92644Medicare UPIN