Provider Demographics
NPI:1003809617
Name:GRISHKIN, BRENT A (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:A
Last Name:GRISHKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4308
Mailing Address - Country:US
Mailing Address - Phone:865-769-8635
Mailing Address - Fax:865-769-8631
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-769-8635
Practice Address - Fax:865-769-8631
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27702208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01121Medicare UPIN
TN3734041Medicare PIN