Healthcare Provider Details

I. General information

NPI: 1215376819
Provider Name (Legal Business Name): SPYRIDON MONASTIRIOTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE STE 300
MEMPHIS TN
38104-6655
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6018
  • Fax: 901-201-4203
Mailing address:
  • Phone: 901-478-0954
  • Fax: 901-478-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number63966
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: