Basic Information
| Provider Information | |||||||||
| NPI: | 1174939441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEMEH | ||||||||
| FirstName: | KELVIN | ||||||||
| MiddleName: | ONYEKA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 UNION AVE STE 330 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014780954 | ||||||||
| FaxNumber: | 9014780951 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 EASTMORELAND AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381047544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017587970 | ||||||||
| FaxNumber: | 9012666425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036.148449 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | R74578 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 64237 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.