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General NPI Number Information
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NPI Number | 1871354167
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Entity Type | Individual
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Provider Name | TRIVIKRAM DASU PHD.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 5846 DISTRIBUTION DR
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City | MEMPHIS
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State | TN
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Zip | 38141-8203
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Country | US
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Telephone | 877-598-2522
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Fax | 901-495-2396
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Provider Business Mailing Address
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Address Line | 5846 DISTRIBUTION DR
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City | MEMPHIS
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State | TN
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Zip | 38141-8203
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Country | US
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Telephone | 757-275-5878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QI0000X
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Taxonomy Name | Immunology Pathology Specialist/Technologist
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License Number | 26766
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License Number State | TN
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