Provider Demographics
NPI:1306976212
Name:RAWTANI, PALLAVI V (MD)
Entity type:Individual
Prefix:MRS
First Name:PALLAVI
Middle Name:V
Last Name:RAWTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MADISON AVE
Mailing Address - Street 2:SUITE 704
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3403
Mailing Address - Country:US
Mailing Address - Phone:901-527-6556
Mailing Address - Fax:901-525-5441
Practice Address - Street 1:910 MADISON AVE
Practice Address - Street 2:SUITE 704
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3403
Practice Address - Country:US
Practice Address - Phone:901-527-6556
Practice Address - Fax:901-525-5441
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0044953OtherBLUE SHIELD PROVIDER #
TN116425OtherUNISON HEALTH PLAN PROV#
TN3178533Medicare ID - Type Unspecified
TN116425OtherUNISON HEALTH PLAN PROV#