Healthcare Provider Details

I. General information

NPI: 1083722201
Provider Name (Legal Business Name): OSCAR H GRANDAS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY E120
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

DEPT 888062
KNOXVILLE TN
37995-8062
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-6050
  • Fax: 865-305-8166
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number38851
License Number StateTN

VIII. Authorized Official

Name: OSCAR H GRANDAS
Title or Position: PRESIDENT
Credential: MD
Phone: 865-544-6050