Healthcare Provider Details

I. General information

NPI: 1790887230
Provider Name (Legal Business Name): MOHAMMED MUNIR MOTIWALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11293 MEMPHIS ARLINGTON RD
ARLINGTON TN
38002-7978
US

IV. Provider business mailing address

1994 HAMBURG CV
CORDOVA TN
38016-4002
US

V. Phone/Fax

Practice location:
  • Phone: 901-745-7219
  • Fax: 901-745-7262
Mailing address:
  • Phone: 901-745-7219
  • Fax: 901-745-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD28679
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: