Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | M2993 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | PENDING | TN |
Y | 207RI0011X | Interventional Cardiology | 43424 | TN |
NPI | 1124108493 |
---|---|
Provider Name | Dr. Santhosh Koshy |
First Address | Memphis, TN 38103-2807 |
Second Address | Memphis, TN 38103-3409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 11/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176385601 | (05) | TX |
H48979 | (02) |