Healthcare Provider Details

I. General information

NPI: 1235234808
Provider Name (Legal Business Name): IBRAHIM A SULTAN-ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

9692 WOODLAND VISTA DR
CORDOVA TN
38018-3621
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-3028
  • Fax: 844-308-5077
Mailing address:
  • Phone: 865-776-7348
  • Fax: 901-255-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number37191
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number37191
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD37191
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: