Provider Demographics
NPI:1902396559
Name:MISULIS, EDWARD NICHOLAS (MBBS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:NICHOLAS
Last Name:MISULIS
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1161 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0011
Mailing Address - Country:US
Mailing Address - Phone:615-322-0417
Mailing Address - Fax:
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0011
Practice Address - Country:US
Practice Address - Phone:615-322-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1582592084N0400X
MEMD256202084N0400X
ORMD2138722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology