Provider Demographics
NPI:1275836371
Name:SETH, ANKUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:
Last Name:SETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANKUR
Other - Middle Name:
Other - Last Name:SETH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1670 RED BARN DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6090
Mailing Address - Country:US
Mailing Address - Phone:901-283-6575
Mailing Address - Fax:
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-866-8360
Practice Address - Fax:901-302-2360
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50863207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200940001Medicaid
MS09235864Medicaid
TNQ002154Medicaid
TN103I119699Medicare PIN