MEDICARE: DR. JIVAN DALSANIA 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	207L00000X	Anesthesiology Physician	MD17381	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050049460	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
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	3018829	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1548293079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIVAN DALSANIA MD

Provider Business Mailing Address
First Line	:	PO BOX 171181
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38187-1181
Country	:	US
Telephone Number	:	901-682-2872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1068 CRESTHAVEN RD
Second Line	:	SUITE 150
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0800
Country	:	US
Telephone Number	:	901-682-6828
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	10/26/2016

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Directions to “ DR. JIVAN DALSANIA MD” Practice Location

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