Healthcare Provider Details

I. General information

NPI: 1366108441
Provider Name (Legal Business Name): CERASMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 MARYLAND WAY STE 100
BRENTWOOD TN
37027-5048
US

IV. Provider business mailing address

5400 MARYLAND WAY STE 100
BRENTWOOD TN
37027-5048
US

V. Phone/Fax

Practice location:
  • Phone: 615-979-9453
  • Fax:
Mailing address:
  • Phone: 615-979-9453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD GLEN BLASCHKE II
Title or Position: MANAGER
Credential: MD
Phone: 615-979-9453