Basic Information
| Provider Information | |||||||||
| NPI: | 1821019845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDANI | ||||||||
| FirstName: | MOHAMAD | ||||||||
| MiddleName: | ANIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 DR DB TODD JR BLVD | ||||||||
| Address2: | FAMILY AND COMMUNITY MEDICINE DEPARTMENT | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372083599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275817 | ||||||||
| FaxNumber: | 6153275634 | ||||||||
| Practice Location | |||||||||
| Address1: | MMC MEDICAL SHOOL FAMILY & COMMUNITY MEDICINE DEPARTME | ||||||||
| Address2: | 1005 DR. D. B. TODD JR. BLVD. | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372083599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275817 | ||||||||
| FaxNumber: | 6153275634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41790 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3335750 | 05 | TN | MEDICAID |