Healthcare Provider Details

I. General information

NPI: 1609810019
Provider Name (Legal Business Name): HARESH K MIRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 HOLLY ST
KNOXVILLE TN
37927-3730
US

IV. Provider business mailing address

417 HOLLY ST P.O.BOX # 3730
KNOXVILLE TN
37917-7815
US

V. Phone/Fax

Practice location:
  • Phone: 865-922-1400
  • Fax: 865-922-0928
Mailing address:
  • Phone: 865-922-1400
  • Fax: 865-922-0928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000014547
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: