Provider Demographics
NPI:1902903651
Name:ANSARI, SIKANDER JAWEED (MD)
Entity Type:Individual
Prefix:DR
First Name:SIKANDER
Middle Name:JAWEED
Last Name:ANSARI
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 1:5301 VIRGINIA WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-221-4474
Mailing Address - Fax:615-234-3774
Practice Address - Street 1:5301 VIRGINIA WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7541
Practice Address - Country:US
Practice Address - Phone:615-221-4474
Practice Address - Fax:615-234-3774
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37209207ZP0102X
KY37707207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069560Medicaid
OH2587348Medicaid
GA326037852AMedicaid
AL009989915Medicaid
TN000000026730OtherTLC TENNCARE
TN100042252OtherPHP TENNCARE
TN144256OtherUNISON TENNCARE
TN4060433OtherBLUE CROSS
TN3881736Medicaid
F58642Medicare UPIN
TN000000026730OtherTLC TENNCARE
TN3881736Medicare ID - Type Unspecified