Healthcare Provider Details

I. General information

NPI: 1134138761
Provider Name (Legal Business Name): NILOOFAR MOTAKEF BAYMILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 RIDGEWAY CENTER PKWY STE 101
MEMPHIS TN
38120-4011
US

IV. Provider business mailing address

1938 ROWAN LN
GERMANTOWN TN
38138-2564
US

V. Phone/Fax

Practice location:
  • Phone: 901-288-6255
  • Fax:
Mailing address:
  • Phone: 901-755-0208
  • Fax: 901-861-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number37022
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: