Provider Demographics
NPI:1174519284
Name:MISHU, DINA H (MD)
Entity type:Individual
Prefix:MRS
First Name:DINA
Middle Name:H
Last Name:MISHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 BUSINESS PARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3676
Mailing Address - Country:US
Mailing Address - Phone:615-851-7865
Mailing Address - Fax:615-851-7853
Practice Address - Street 1:3103 BUSINESS PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3676
Practice Address - Country:US
Practice Address - Phone:615-851-7865
Practice Address - Fax:615-851-7853
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3127862OtherBLUE CROSS
2950507011OtherCIGNA HMO
677740OtherAETNA
1240296OtherUNITED HEALTHCARE HMO
TN3038469Medicaid
2950507013OtherCIGNA COMM
TN3127862OtherBLUE CROSS