Healthcare Provider Details

I. General information

NPI: 1073036232
Provider Name (Legal Business Name): MIRIAM WING SAN TSAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE SUITE 300
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

P O BOX 1000 DEPT 457
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-0792
  • Fax: 901-266-6415
Mailing address:
  • Phone: 901-275-3662
  • Fax: 901-271-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number56810
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: