Healthcare Provider Details

I. General information

NPI: 1033579867
Provider Name (Legal Business Name): STANISLAV OZHOG D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 08/19/2024
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LAUREL AVE. STE 206
KNOXVILLE TN
37916
US

IV. Provider business mailing address

2001 LAUREL AVE. STE 206
KNOXVILLE TN
37916
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-3131
  • Fax: 865-212-6323
Mailing address:
  • Phone: 865-524-3131
  • Fax: 865-212-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.152181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: