Healthcare Provider Details

I. General information

NPI: 1467034744
Provider Name (Legal Business Name): KRISHNA P DETROJA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 S NORTHSHORE DR
KNOXVILLE TN
37919-8002
US

IV. Provider business mailing address

7503 S NORTHSHORE DR
KNOXVILLE TN
37919-8002
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-1300
  • Fax:
Mailing address:
  • Phone: 865-531-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5925
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: