Healthcare Provider Details

I. General information

NPI: 1821677246
Provider Name (Legal Business Name): THIRUMALAIVASAN DHASAKEERTHI M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MADISON AVE STE 801
MEMPHIS TN
38103-3410
US

IV. Provider business mailing address

1187 NATCHEZ PT APT 54
MEMPHIS TN
38103-0977
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8805
  • Fax:
Mailing address:
  • Phone: 531-213-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number73934
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number73934
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: