Provider Demographics
NPI:1225340557
Name:KHAIRE, SUSHANT SHARAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHANT
Middle Name:SHARAD
Last Name:KHAIRE
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 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:901-478-0966
Mailing Address - Fax:901-478-0951
Practice Address - Street 1:1211 UNION AVE STE 965
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-435-8550
Practice Address - Fax:901-478-0781
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS794L207R00000X
ALMD.35774207RI0011X
TN65853207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL199298Medicaid
AL199998Medicaid