Provider Demographics
NPI:1821299512
Name:PATHAK, MINESH BABUL (MD)
Entity Type:Individual
Prefix:
First Name:MINESH
Middle Name:BABUL
Last Name:PATHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3950 NEW COVINGTON PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2591
Mailing Address - Country:US
Mailing Address - Phone:901-382-5256
Mailing Address - Fax:901-382-3731
Practice Address - Street 1:3950 NEW COVINGTON PIKE STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2591
Practice Address - Country:US
Practice Address - Phone:901-382-5256
Practice Address - Fax:901-382-3731
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000043921207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92432Medicare UPIN