Provider Demographics
NPI:1043239965
Name:ASLAM, TANVEER (MD)
Entity type:Individual
Prefix:MR
First Name:TANVEER
Middle Name:
Last Name:ASLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 COOK ST STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1899
Mailing Address - Country:US
Mailing Address - Phone:731-256-6028
Mailing Address - Fax:731-256-6035
Practice Address - Street 1:1950 COOK STREET
Practice Address - Street 2:SUITE D
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1899
Practice Address - Country:US
Practice Address - Phone:731-285-7999
Practice Address - Fax:731-285-6917
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3859099Medicaid
TNBA7040152OtherDEA
TNBA7040152OtherDEA
TN3859099Medicare ID - Type Unspecified