MEDICARE: MAHIR R AWDEH 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	207RC0000X	Cardiovascular Disease Physician	10521	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

General Provider Information

NPI Number	:	1710934153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHIR R AWDEH M.D.

Provider Business Mailing Address
First Line	:	6005 PARK AVENUE
Second Line	:	SUITE 500 B
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5215
Country	:	US
Telephone Number	:	901-683-6925
Fax Number	:	901-684-1435

Provider Business Practice Location Address
First Line	:	6005 PARK AVENUE
Second Line	:	SUITE 500 B
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5215
Country	:	US
Telephone Number	:	901-683-6925
Fax Number	:	901-684-1435

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/30/2021

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