Healthcare Provider Details

I. General information

NPI: 1982961058
Provider Name (Legal Business Name): RACHEL LANDISCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST FL 2
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

49 N DUNLAP ST FL 2
MEMPHIS TN
38103-2802
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-287-6670
Mailing address:
  • Phone: 901-287-6219
  • Fax: 901-287-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number65996
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number65996
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: