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NPI Code Detail

MEDICARE: DR. ELIZABETH ANNE KEAN-GROARK MD

MEDICARE: DR. ELIZABETH ANNE KEAN-GROARK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician75088TN
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255918421
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH ANNE KEAN-GROARK MD
Provider Business Mailing Address
First Line : 1924 ALCOA HWY
Second Line :
City : KNOXVILLE
State : TN
Zip : 37920-1511
Country : US
Telephone Number : 865-305-9000
Fax Number :
Provider Business Practice Location Address
First Line : 1924 ALCOA HWY
Second Line :
City : KNOXVILLE
State : TN
Zip : 37920-1511
Country : US
Telephone Number : 865-305-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 03/19/2026

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