MEDICARE: RAED E IMSEIS 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	207R00000X	Internal Medicine Physician	36729	TN
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	36729	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4281641	OTHER	TN	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2344289	OTHER	TN	UHC
7	7596403	OTHER		AETNA

General Provider Information

NPI Number	:	1528004314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAED E IMSEIS MD

Provider Business Mailing Address
First Line	:	PO BOX 38773
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-0773
Country	:	US
Telephone Number	:	901-484-3173
Fax Number	:	901-754-8058

Provider Business Practice Location Address
First Line	:	6027 WALNUT GROVE RD STE 312
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2128
Country	:	US
Telephone Number	:	901-484-3173
Fax Number	:	901-754-8058

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/07/2023

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Directions to “ RAED E IMSEIS MD” Practice Location

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