Healthcare Provider Details

I. General information

NPI: 1801826961
Provider Name (Legal Business Name): EMMANUEL ILOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 NEW COVINGTON PIKE STE 130
MEMPHIS TN
38128-2595
US

IV. Provider business mailing address

3950 NEW COVINGTON PIKE STE 130
MEMPHIS TN
38128-2595
US

V. Phone/Fax

Practice location:
  • Phone: 901-388-0404
  • Fax: 901-388-0484
Mailing address:
  • Phone: 901-388-0404
  • Fax: 901-388-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38934
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number038934
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: