Healthcare Provider Details

I. General information

NPI: 1528097771
Provider Name (Legal Business Name): CHRIS A KLENCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 LAKE LOUDON BLVD
KNOXVILLE TN
37996-2674
US

IV. Provider business mailing address

1551 LAKE LOUDON BLVD
KNOXVILLE TN
37916-4009
US

V. Phone/Fax

Practice location:
  • Phone: 865-475-4484
  • Fax:
Mailing address:
  • Phone: 865-475-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01060568A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number41783
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: