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Contact Information

MIMILY HARSONO, MD
UNIVERSITY OF TENNESSEE (DIVISION OF NEONATOLOGY)
853 JEFFERSON AVENUE, SUITE-201, NEWBORN CENTER
MEMPHIS, TN38103
 Phone: 901-448-5950
 Fax: 901-448-1691
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neonatal-Perinatal Medicine

2080N0001X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MIMILY HARSONO · (Female)

NPI Number 1003137571
Status Active
Credentials MD
Entity Individual
Enumeration date 06/18/2010
Last updated 10/08/2018 - About 12 months ago
Sole proprietor 1 No
Identifiers
  • TN License # 50025
  • AL Medicaid 177423
  • AR Medicaid 197560001
  • GA Medicaid 00179412A
  • MI Medicaid 1003137571
  • MO Medicaid 1003137571
  • MS Medicaid 02507295
  • TN Medicaid 1532008
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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