Provider Demographics
NPI:1194773762
Name:OKTAEI, HOOMAN (MD)
Entity type:Individual
Prefix:DR
First Name:HOOMAN
Middle Name:
Last Name:OKTAEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 US HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-2212
Mailing Address - Country:US
Mailing Address - Phone:901-864-8017
Mailing Address - Fax:901-201-5007
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-864-8017
Practice Address - Fax:901-201-5007
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37743207RE0101X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3887609Medicaid
TN3887609Medicare ID - Type Unspecified
TN3887609Medicaid