Provider Demographics
NPI:1295785095
Name:ISTANBOULI, WAJIH (MD)
Entity type:Individual
Prefix:
First Name:WAJIH
Middle Name:
Last Name:ISTANBOULI
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:P O BOX 1000 DEPT 978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-9900
Mailing Address - Fax:901-752-2335
Practice Address - Street 1:6570 SUMMER OAKS CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2857
Practice Address - Country:US
Practice Address - Phone:901-373-7100
Practice Address - Fax:901-842-0020
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0106207R00000X
TN40248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125549001Medicaid
AR5J358Medicare ID - Type Unspecified