Healthcare Provider Details

I. General information

NPI: 1245371400
Provider Name (Legal Business Name): A. BERNHARD KLIEFOTH III MD, FACS, FAHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 OFFICE PARK CIR
KNOXVILLE TN
37909-1162
US

IV. Provider business mailing address

PO BOX 51648
KNOXVILLE TN
37950-1648
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-9400
  • Fax:
Mailing address:
  • Phone: 865-524-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD13445
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberC33599
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD7126
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: