Provider Demographics
NPI:1932868908
Name:MIDSOUTH RHEUMATOLOGY
Entity Type:Organization
Organization Name:MIDSOUTH RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTHALON KUNNATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-370-7406
Mailing Address - Street 1:2028 W POPLAR AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0618
Mailing Address - Country:US
Mailing Address - Phone:901-370-7406
Mailing Address - Fax:833-747-1287
Practice Address - Street 1:2028 W POPLAR AVE STE 108
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-370-7406
Practice Address - Fax:833-747-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty