Provider Demographics
NPI:1619416633
Name:P PUSHPANSHU MD PLLC
Entity Type:Organization
Organization Name:P PUSHPANSHU MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PUSHPANSHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSHPANSHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-826-1977
Mailing Address - Street 1:495 HUNTERS MILL CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2434
Mailing Address - Country:US
Mailing Address - Phone:901-826-1977
Mailing Address - Fax:
Practice Address - Street 1:495 HUNTERS MILL CV
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2434
Practice Address - Country:US
Practice Address - Phone:901-826-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty