Provider Demographics
NPI:1235297847
Name:KOUCHEKI, MOHAMMAD HASSAN (MD, PC)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:HASSAN
Last Name:KOUCHEKI
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ELMO DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4807
Mailing Address - Country:US
Mailing Address - Phone:931-484-5525
Mailing Address - Fax:931-456-8320
Practice Address - Street 1:40 ELMO DR
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4807
Practice Address - Country:US
Practice Address - Phone:931-484-5525
Practice Address - Fax:931-456-8320
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000012315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3172878Medicaid
TNB59374Medicare UPIN
TN3172878Medicare PIN