Individual
THOMAS J NEDUMTHOTTATHIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
112 AIRPORT BUSINESS PARK DR, SUITE F, SHELBYVILLE, TN 37160-7446
(931) 685-8620
(931) 685-8621
Mailing address
112 AIRPORT BUSINESS PARK DR, SUITE F, SHELBYVILLE, TN 37160-7446
(931) 685-8620
(931) 685-8621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA08034600
NJ
207R00000X
Internal Medicine Physician
Primary
42606
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507217
—
TN
05
—
1516785
—
TN
01
—
4163983
BCBS
TN
01
—
4239941
BCBS
TN
01
—
42635
MEDICAID TLC
TN
Enumeration date
12/14/2006
Last updated
11/17/2010
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