Provider Demographics
NPI:1295820280
Name:QURESKI, MOHAMMAD HUMAYUN AZIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HUMAYUN AZIZ
Last Name:QURESKI
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 1:805 MEADOWLARK LANE
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072
Mailing Address - Country:US
Mailing Address - Phone:615-859-9380
Mailing Address - Fax:615-859-9389
Practice Address - Street 1:805 MEADOWLARK LANE
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-859-9380
Practice Address - Fax:615-859-9389
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD010174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B02968Medicare UPIN
TN3162859Medicare ID - Type Unspecified