Basic Information
| Provider Information | |||||||||
| NPI: | 1275836371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SETH | ||||||||
| FirstName: | ANKUR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SETH | ||||||||
| OtherFirstName: | ANKUR | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1670 RED BARN DR | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380166090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012836575 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6019 WALNUT GROVE RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018668360 | ||||||||
| FaxNumber: | 9013022360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2010 | ||||||||
| LastUpdateDate: | 10/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50863 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 50863 | TN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 200940001 | 05 | AR | MEDICAID | 09235864 | 05 | MS | MEDICAID | Q002154 | 05 | TN | MEDICAID |