Provider Demographics
NPI:1487640892
Name:GHARAVI, HESAMM ELMI (MD)
Entity Type:Individual
Prefix:
First Name:HESAMM
Middle Name:ELMI
Last Name:GHARAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:900 E HILL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2565
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:9957 SHERRILL BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3366
Practice Address - Country:US
Practice Address - Phone:656-932-2558
Practice Address - Fax:865-691-7888
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000038878207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00369244OtherRR MEDICARE
TN3325815Medicaid
TN4135981OtherBLUE CROSS PROVIDER
KY7100231170Medicaid
TN4135981OtherBLUE CROSS PROVIDER
P00369244OtherRR MEDICARE