Provider Demographics
NPI:1760643738
Name:TENNESSEE CARDIOVASCULAR INSTITUTE
Entity type:Organization
Organization Name:TENNESSEE CARDIOVASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-369-6052
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3035
Mailing Address - Country:US
Mailing Address - Phone:901-369-6052
Mailing Address - Fax:
Practice Address - Street 1:3960 KNIGHT ARNOLD RD
Practice Address - Street 2:SUITE 215
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3035
Practice Address - Country:US
Practice Address - Phone:901-369-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38037207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3332304Medicare PIN