Provider Demographics
NPI:1497746838
Name:ALISSANDRATOS, JANE KIRK (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:KIRK
Last Name:ALISSANDRATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TRINITY CREEK CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2279
Mailing Address - Country:US
Mailing Address - Phone:901-309-5000
Mailing Address - Fax:901-309-5008
Practice Address - Street 1:540 TRINITY CREEK CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2279
Practice Address - Country:US
Practice Address - Phone:901-309-5000
Practice Address - Fax:901-309-5008
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12486207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A97122Medicare UPIN
3006604Medicare ID - Type Unspecified