Healthcare Provider Details

I. General information

NPI: 1164819447
Provider Name (Legal Business Name): KAUSHIK NIRANJAN PARSHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-4910
  • Fax: 901-226-4915
Mailing address:
  • Phone: 901-226-4910
  • Fax: 901-226-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number60953
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: