Healthcare Provider Details

I. General information

NPI: 1003801937
Provider Name (Legal Business Name): MENE SUGAGE ZUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 BRIARVILLE RD
MADISON TN
37115-5127
US

IV. Provider business mailing address

1308 BRIARVILLE RD
MADISON TN
37115-5127
US

V. Phone/Fax

Practice location:
  • Phone: 615-868-3131
  • Fax: 615-515-0205
Mailing address:
  • Phone: 615-868-3131
  • Fax: 615-515-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number026535
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: