Basic Information
| Provider Information | |||||||||
| NPI: | 1417056250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QURESHI | ||||||||
| FirstName: | SHOAIB | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7865 EDUCATORS LANE, | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381338191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013849920 | ||||||||
| FaxNumber: | 9019377879 | ||||||||
| Practice Location | |||||||||
| Address1: | 7865 EDUCATORS LANE, | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381338191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013849920 | ||||||||
| FaxNumber: | 9019377879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41376 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3831126 | 05 | TN | MEDICAID |