Healthcare Provider Details

I. General information

NPI: 1114938578
Provider Name (Legal Business Name): CHANGHYUN MICHAEL CHOI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: C MICHAEL CHOI MD

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

IV. Provider business mailing address

3495 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

V. Phone/Fax

Practice location:
  • Phone: 901-526-7444
  • Fax: 901-526-0791
Mailing address:
  • Phone: 901-526-7444
  • Fax: 901-271-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number41778
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35-050962C
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number41778
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: