Healthcare Provider Details

I. General information

NPI: 1043507965
Provider Name (Legal Business Name): ANDREW W DAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK RIDGE TURNPIKE SUITE A-402
OAK RIDGE TN
37830
US

IV. Provider business mailing address

1450 DOWELL SPRINGS BLVD SUITE 300
KNOXVILLE TN
37909
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-8812
  • Fax: 865-824-4886
Mailing address:
  • Phone: 865-637-8812
  • Fax: 865-637-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number54290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: