Healthcare Provider Details

I. General information

NPI: 1558777821
Provider Name (Legal Business Name): INDERJEET SINGH BRAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 WALNUT GROVE RD STE 209
MEMPHIS TN
38120-2112
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 901-681-0778
  • Fax: 901-821-9987
Mailing address:
  • Phone: 901-681-0778
  • Fax: 901-821-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number58539
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: