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General NPI Number Information
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NPI Number | 1346515897
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Entity Type | Organization
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Legal Business Name | TIF W SIRAGUSA
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 5651 FRIST BLVD SUITE 414
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City | HERMITAGE
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State | TN
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Zip | 37076-2054
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Country | US
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Telephone | 615-884-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 5651 FRIST BLVD SUITE 414
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City | HERMITAGE
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State | TN
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Zip | 37076-2054
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Country | US
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Telephone | 615-884-7600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIF WILLIAM SIRAGUSA
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Credential | MD
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Telephone | 615-884-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 43966
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License Number State | TN
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