MIMILY HARSONO MD NPI 1003137571

NPI Information

  • NPI: 1003137571
  • Provider Name: MIMILY HARSONO, MD
  • Classification: Pediatrics - 2080N0001X
  • Specialization: Neonatal-Perinatal Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 877 JEFFERSON AVE
    MEMPHIS, TN
    ZIP 38103
  • Phone: (901) 545-7100

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NPI Details

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:

877 JEFFERSON AVE
MEMPHIS, TN
ZIP 38103-807
Phone: (901) 545-7100

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 2/25/2025.

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
12080N0001XPediatricsNeonatal-Perinatal Medicine50025TENNESSEEYes

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 Other Provider Identifier Issuer
1197560001MEDICAIDARKANSAS
2177423MEDICAIDALABAMA
31003137571MEDICAIDMICHIGAN
402507295MEDICAIDMISSISSIPPI
500179412AMEDICAIDGEORGIA
61003137571MEDICAIDMISSOURI
71532008MEDICAIDTENNESSEE

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: 3/30/2025

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