Provider Demographics
NPI:1821019845
Name:SIDANI, MOHAMAD ANIS (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:ANIS
Last Name:SIDANI
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Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:1005 DR DB TODD JR BLVD
Mailing Address - Street 2:FAMILY AND COMMUNITY MEDICINE DEPARTMENT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3599
Mailing Address - Country:US
Mailing Address - Phone:615-327-5817
Mailing Address - Fax:615-327-5634
Practice Address - Street 1:MMC MEDICAL SHOOL FAMILY & COMMUNITY MEDICINE DEPARTME
Practice Address - Street 2:1005 DR. D. B. TODD JR. BLVD.
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3599
Practice Address - Country:US
Practice Address - Phone:615-327-5817
Practice Address - Fax:615-327-5634
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-12-01
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Provider Licenses
StateLicense IDTaxonomies
TN41790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3335750Medicaid
TN3335750Medicare PIN
TN3335750Medicaid