Healthcare Provider Details

I. General information

NPI: 1487675831
Provider Name (Legal Business Name): MIHAIL MARIUS SUBTIRELU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLINCH AVE STE 310
KNOXVILLE TN
37916-2220
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3111
  • Fax: 877-761-6691
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number38810
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: