Healthcare Provider Details

I. General information

NPI: 1992949309
Provider Name (Legal Business Name): FARRUKH GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MADISON AVE STE 500
MEMPHIS TN
38103-3410
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-8013
  • Fax:
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number49164
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number45662
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: