MEDICARE: DR. THOMAS KLEISLI 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	208600000X	Surgery Physician	R70964	AZ
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A120943	CA
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	64530	TN

General Provider Information

NPI Number	:	1518195627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS KLEISLI M.D.

Provider Business Mailing Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-236-0508
Fax Number	:	901-682-2143

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-236-0508
Fax Number	:	901-682-2143

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

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	02/24/2022

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