Provider Demographics
NPI:1871694877
Name:KAVOUSSI, HAROLD PETER (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:PETER
Last Name:KAVOUSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:336 POPLAR VIEW PKWY
Mailing Address - Street 2:1
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017
Mailing Address - Country:US
Mailing Address - Phone:901-854-6220
Mailing Address - Fax:901-854-6808
Practice Address - Street 1:336 POPLAR VIEW PKWY
Practice Address - Street 2:1
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-854-6220
Practice Address - Fax:901-854-6808
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD12179207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3877327Medicaid
TN3877326Medicare ID - Type Unspecified
A51371Medicare UPIN