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NPI Code Detail

MEDICARE: WAYNE MICHAEL EBERENZ M.D.

MEDICARE: WAYNE MICHAEL EBERENZ M.D.
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 Physician29883TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396741070
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE MICHAEL EBERENZ M.D.
Provider Business Mailing Address
First Line : 1112 E WEISGARBER RD
Second Line : STE 201
City : KNOXVILLE
State : TN
Zip : 37909-2647
Country : US
Telephone Number : 865-558-9862
Fax Number : 865-584-3478
Provider Business Practice Location Address
First Line : 1112 E WEISGARBER RD
Second Line : STE 201
City : KNOXVILLE
State : TN
Zip : 37909-2647
Country : US
Telephone Number : 865-558-9862
Fax Number : 865-584-3478
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 09/02/2011

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Directions to “ WAYNE MICHAEL EBERENZ M.D.” Practice Location

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