MEDICARE: DR. CARYN CORNELIA WUNDERLICH 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
1	2085R0202X	Diagnostic Radiology Physician	MD 0000026325	TN
2	2085R0202X	Diagnostic Radiology Physician	MD26325	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1679505382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARYN CORNELIA WUNDERLICH MD

Provider Business Mailing Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	STE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2457
Country	:	US
Telephone Number	:	865-584-0291
Fax Number	:	865-584-4426

Provider Business Practice Location Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	STE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-584-0291
Fax Number	:	865-584-4426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/21/2023

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Directions to “ DR. CARYN CORNELIA WUNDERLICH MD” Practice Location

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