Provider Demographics
NPI:1730829219
Name:ILSTRUP, SPENCER (MD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:ILSTRUP
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:TRISTAR CENTENNIAL PARTHENON PAVILION
Mailing Address - Street 2:2401 PARMAN PLACE
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-342-3965
Mailing Address - Fax:
Practice Address - Street 1:TRISTAR CENTENNIAL PARTHENON PAVILION 2401 PARMAN PLACE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-342-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program