Healthcare Provider Details

I. General information

NPI: 1144485418
Provider Name (Legal Business Name): VIJAYKUMAR AGRAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 JEFFERSON AVENUE DEPARTMENT OF RADIOLOGY F150 CHANDLER
MEMPHIS TN
38163-0001
US

IV. Provider business mailing address

865 JEFFERSON AVENUE DEPARTMENT OF RADIOLOGY F150 CHANDLER
MEMPHIS TN
38163-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-4454
  • Fax:
Mailing address:
  • Phone: 901-448-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number44518
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: