MIMILY HARSONO MD NPI 1003137571

NPI Information

NPI: 1003137571
Provider Name: MIMILY HARSONO, MD
Classification: Pediatrics - 2080N0001X
Entity Type: Individual

Specialization: Neonatal-Perinatal Medicine

PECOS Registration: Yes

Address:
UNIVERSITY OF TENNESSEE (DIVISION OF NEONATOLOGY)
853 JEFFERSON AVENUE, SUITE-201, NEWBORN CENTER
MEMPHIS, TN
ZIP 38103
Phone: (901) 448-5950
Get Directions

Mimily Harsono, MD is a neonatal-perinatal medicine pediatrics in Memphis, TN. The provider is a pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. Mimily Harsono, MD NPI is 1003137571. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

UNIVERSITY OF TENNESSEE (DIVISION OF NEONATOLOGY)
853 JEFFERSON AVENUE, SUITE-201, NEWBORN CENTER
MEMPHIS, TN
ZIP 38103
Phone: (901) 448-5950
Fax: (901) 448-1691

The NPI 1003137571 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/18/2010 and was last updated on 10/8/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	50025	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	197560001	MEDICAID	ARKANSAS
2	1003137571	MEDICAID	MISSOURI
3	177423	MEDICAID	ALABAMA
4	00179412A	MEDICAID	GEORGIA
5	02507295	MEDICAID	MISSISSIPPI
6	1003137571	MEDICAID	MICHIGAN
7	1532008	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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