Provider Demographics
NPI:1477642817
Name:PUSHPANSHU, PUSHPANSHU (MD)
Entity type:Individual
Prefix:DR
First Name:PUSHPANSHU
Middle Name:
Last Name:PUSHPANSHU
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 1:495 HUNTERS MILL CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2434
Mailing Address - Country:US
Mailing Address - Phone:901-826-1977
Mailing Address - Fax:901-826-1977
Practice Address - Street 1:495 HUNTERS MILL CV
Practice Address - Street 2:VA NORTH CLINIC
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2434
Practice Address - Country:US
Practice Address - Phone:901-826-1977
Practice Address - Fax:901-826-1977
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN029566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine