Healthcare Provider Details

I. General information

NPI: 1063630093
Provider Name (Legal Business Name): MICHAEL KEENE MUHLERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE MPRG
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

5959 PARK AVE MEMPHIS PHYSICIANS RADIOLOGY PRACTICE GROUP
MEMPHIS TN
38119-5198
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-3213
  • Fax: 901-765-1727
Mailing address:
  • Phone: 901-765-3213
  • Fax: 901-765-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19865
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042710
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberE-5336
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number19865
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-5336
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number42710
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number32039
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: