Healthcare Provider Details

I. General information

NPI: 1528004314
Provider Name (Legal Business Name): RAED E IMSEIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/07/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 WALNUT GROVE RD STE 312
MEMPHIS TN
38120-2128
US

IV. Provider business mailing address

PO BOX 38773
GERMANTOWN TN
38183-0773
US

V. Phone/Fax

Practice location:
  • Phone: 901-484-3173
  • Fax: 901-754-8058
Mailing address:
  • Phone: 901-484-3173
  • Fax: 901-754-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36729
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number36729
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: