Provider Demographics
NPI:1285659383
Name:FIELDS, KENNETH I (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:I
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 HUMPHREYS CENTER
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-578-2538
Practice Address - Fax:901-578-2572
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31333207RG0100X, 174400000X, 207RG0100X
MS17091207RG0100X, 174400000X
NY191499207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3124943OtherBLUE CROSS OF TENNESSEE
TN3839852Medicaid
MS05453599Medicaid
AR148888001Medicaid
TN3839852Medicaid
TN3839852Medicaid