MEDICARE: KIMBERLY M GLOW 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
1	208D00000X	General Practice Physician	DR.0062432	CO
2	405300000X	Prevention Professional	036102300	IL
3	261QM2500X	Medical Specialty Clinic/Center	68798	TN

General Provider Information

NPI Number	:	1821220062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M GLOW M.D.

Provider Business Mailing Address
First Line	:	116 AGNES RD STE 200
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-6306
Country	:	US
Telephone Number	:	217-369-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 AGNES RD STE 200
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-6306
Country	:	US
Telephone Number	:	865-229-6575
Fax Number	:	217-215-9876

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

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	03/31/2025

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Directions to “ KIMBERLY M GLOW M.D.” Practice Location

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