Healthcare Provider Details

I. General information

NPI: 1770589988
Provider Name (Legal Business Name): STEPHEN C KISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LAUREL AVE STE 206
KNOXVILLE TN
37916-1865
US

IV. Provider business mailing address

2001 LAUREL AVE STE 206
KNOXVILLE TN
37916-1865
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 NumberMD021237
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: