Provider Demographics
NPI:1629078324
Name:LITZOW, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:LITZOW
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 1000
Mailing Address - Street 2:DEPT # 960
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:901-260-1713
Practice Address - Street 1:7460 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1760
Practice Address - Country:US
Practice Address - Phone:901-763-0200
Practice Address - Fax:901-260-1713
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31104207RC0001X
MS18207207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00854026OtherRAILROAD MEDICARE
AR136044001Medicaid
TN3831621Medicaid
MS00120462Medicaid
TN4270284OtherBCBS TN
TNF77368Medicare UPIN
TN3831621Medicaid
TN103I060414Medicare PIN