MEDICARE: MEMPHIS INTERNAL MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1063497519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMPHIS INTERNAL MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	6005 PARK AVE
Second Line	:	SUITE 900B
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5202
Country	:	US
Telephone Number	:	901-684-1322
Fax Number	:	901-682-6368

Provider Business Practice Location Address
First Line	:	6005 PARK AVE
Second Line	:	SUITE 900B
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5202
Country	:	US
Telephone Number	:	901-684-1322
Fax Number	:	901-682-6368

Authorized Official
Title or Position	:	CHIEF MANAGER
Name	:	FREDERICK R PELZ
Credential	:	MD
Telephone Number	:	901-684-1322

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	08/22/2020

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