Healthcare Provider Details

I. General information

NPI: 1255378238
Provider Name (Legal Business Name): MITCHELL DREW BEATUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120
US

IV. Provider business mailing address

P O BOX 1000 DEPT 0364
MEMPHIS TN
38148-0364
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-3123
  • Fax: 901-767-3884
Mailing address:
  • Phone: 901-767-3123
  • Fax: 901-767-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD26466
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: