MEDICARE: MRS. PALLAVI V RAWTANI MD

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	207Q00000X	Family Medicine Physician	MD0000010815	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0044953	OTHER	TN	BLUE SHIELD PROVIDER #
2	116425	OTHER	TN	UNISON HEALTH PLAN PROV#

General Provider Information

NPI Number	:	1306976212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PALLAVI V RAWTANI MD

Provider Business Mailing Address
First Line	:	910 MADISON AVE
Second Line	:	SUITE 704
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3403
Country	:	US
Telephone Number	:	901-527-6556
Fax Number	:	901-525-5441

Provider Business Practice Location Address
First Line	:	910 MADISON AVE
Second Line	:	SUITE 704
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3403
Country	:	US
Telephone Number	:	901-527-6556
Fax Number	:	901-525-5441

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/09/2007

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