Provider Demographics
NPI:1962453225
Name:KATHAWALA, AHSAN H (MD)
Entity type:Individual
Prefix:DR
First Name:AHSAN
Middle Name:H
Last Name:KATHAWALA
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:PO BOX 383317
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-3317
Mailing Address - Country:US
Mailing Address - Phone:901-346-1800
Mailing Address - Fax:901-346-0043
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 501
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-346-1800
Practice Address - Fax:901-346-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000115782OtherUNISON HEALTH PLAN
MS0118459Medicaid
0441108OtherUNITED HEALTHCARE
4028944OtherBCBST
3027560OtherAETNA
5009811OtherTLC FAMILY CARE
TN3804749Medicaid
8394237OtherCIGNA
TNG32312Medicare UPIN
TN3374672Medicare ID - Type Unspecified