MEDICARE: KENNY R SIZEMORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	23575	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0030656	OTHER	TN	RR MEDICARE PIN

General Provider Information

NPI Number	:	1346229861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY R SIZEMORE MD

Provider Business Mailing Address
First Line	:	1225 E WEISGARBER RD
Second Line	:	STE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2604
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	8975 EXECUTIVE PARK DR
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-3624
Country	:	US
Telephone Number	:	865-691-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	11/01/2016

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Directions to “ KENNY R SIZEMORE MD” Practice Location

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