Healthcare Provider Details

I. General information

NPI: 1982748133
Provider Name (Legal Business Name): THRELKELD THRELKELD AND OMER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD SUITE 250
MEMPHIS TN
38119-0800
US

IV. Provider business mailing address

1068 CRESTHAVEN RD SUITE 250
MEMPHIS TN
38119-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-865-3490
  • Fax: 901-864-3499
Mailing address:
  • Phone: 901-865-3490
  • Fax: 901-864-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G THRELKELD
Title or Position: OWNER PARTNER
Credential: M.D.
Phone: 901-685-3490