Provider Demographics
NPI:1528004314
Name:IMSEIS, RAED E (MD)
Entity Type:Individual
Prefix:
First Name:RAED
Middle Name:E
Last Name:IMSEIS
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:PO BOX 38773
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-0773
Mailing Address - Country:US
Mailing Address - Phone:901-484-3173
Mailing Address - Fax:901-754-8058
Practice Address - Street 1:6027 WALNUT GROVE RD STE 312
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2128
Practice Address - Country:US
Practice Address - Phone:901-484-3173
Practice Address - Fax:901-754-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36729207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150205001Medicaid
TN3880287Medicaid
MS06207312Medicaid
TN4281641OtherBCBS
MO209200807Medicaid
TN2344289OtherUHC
7596403OtherAETNA
7596403OtherAETNA
MS06207312Medicaid