Provider Demographics
NPI:1326004128
Name:MAGNOTTI, LOUIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:MAGNOTTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:66 N PAULINE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5105
Mailing Address - Country:US
Mailing Address - Phone:901-448-7642
Mailing Address - Fax:901-448-8015
Practice Address - Street 1:877 JEFFERSON AVENUE
Practice Address - Street 2:ATTN: PROVIDER ENROLLMENT
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-545-6286
Practice Address - Fax:901-545-8122
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2018-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN355042086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3325997Medicaid
TN3325997Medicaid
3325997Medicare ID - Type UnspecifiedTN MEDICARE