MEDICARE: MEHRAN MONAZAM TAVALLAEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD42358	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245437060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHRAN MONAZAM TAVALLAEE M.D.

Provider Business Mailing Address
First Line	:	49 CLEVELAND ST
Second Line	:	SUITE 350
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-9716
Country	:	US
Telephone Number	:	931-456-9434
Fax Number	:	931-456-5061

Provider Business Practice Location Address
First Line	:	133 HAYES ST
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-8000
Country	:	US
Telephone Number	:	931-456-9434
Fax Number	:	931-456-5061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	12/29/2009

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