Provider Demographics
NPI:1972289684
Name:SULAIMANOV, MUKHAMED (MD)
Entity type:Individual
Prefix:
First Name:MUKHAMED
Middle Name:
Last Name:SULAIMANOV
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 1:6025 WALNUT GROVE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2122
Mailing Address - Country:US
Mailing Address - Phone:901-227-5045
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE STE 610
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4806
Practice Address - Country:US
Practice Address - Phone:901-227-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program