Healthcare Provider Details

I. General information

NPI: 1376772541
Provider Name (Legal Business Name): KIRAN KOUSHIK NAGARAJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHNSON BUILDING SUITE 227A 847 MONROE AVENUE
MEMPHIS TN
38163-2140
US

IV. Provider business mailing address

3522 GOLDEN VALLEY LN
BARTLETT TN
38133-5805
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6661
  • Fax:
Mailing address:
  • Phone: 919-961-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71185
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61267
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020-04699
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number71185
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: