Healthcare Provider Details

I. General information

NPI: 1588694913
Provider Name (Legal Business Name): MITCHELL H. GOLDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY SUITE 120
KNOXVILLE TN
37920-2244
US

IV. Provider business mailing address

1924 ALCOA HIGHWAY BOX U-11
KNOXVILLE TN
37920
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9244
  • Fax: 865-305-6958
Mailing address:
  • Phone: 865-305-9244
  • Fax: 865-305-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0015871
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: