Healthcare Provider Details

I. General information

NPI: 1275003295
Provider Name (Legal Business Name): INFORME HEALTHCARE TN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 WALNUT ST
CHATTANOOGA TN
37402-1916
US

IV. Provider business mailing address

2741 W LAYTON AVE STE 106
MILWAUKEE WI
53221-2600
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-7721
  • Fax:
Mailing address:
  • Phone: 414-242-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JODI M CZERNEJEWSKI
Title or Position: OWNER
Credential:
Phone: 414-242-5468