Provider Demographics
NPI:1184718017
Name:KOLEYNI, ASGHAR (MD)
Entity type:Individual
Prefix:DR
First Name:ASGHAR
Middle Name:
Last Name:KOLEYNI
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 1:6005 PARK AVENUE
Mailing Address - Street 2:SUITE 1007B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-761-2400
Mailing Address - Fax:901-761-9892
Practice Address - Street 1:6005 PARK AVENUE
Practice Address - Street 2:SUITE 1007B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-761-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000008349208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3178442Medicaid
B59406Medicare UPIN
3371390Medicare ID - Type Unspecified