Provider Demographics
NPI:1518195627
Name:KLEISLI, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:KLEISLI
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 1:6005 PARK AVE STE 802
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5218
Mailing Address - Country:US
Mailing Address - Phone:901-236-0508
Mailing Address - Fax:901-682-2143
Practice Address - Street 1:6005 PARK AVE STE 802
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5218
Practice Address - Country:US
Practice Address - Phone:901-236-0508
Practice Address - Fax:901-682-2143
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70964208600000X
CAA120943208G00000X
TN64530208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery