Provider Demographics
NPI:1609810019
Name:MIRANI, HARESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:HARESH
Middle Name:K
Last Name:MIRANI
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 1:417 HOLLY ST
Mailing Address - Street 2:P.O.BOX # 3730
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-7815
Mailing Address - Country:US
Mailing Address - Phone:865-922-1400
Mailing Address - Fax:865-922-0928
Practice Address - Street 1:417 HOLLY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37927-3730
Practice Address - Country:US
Practice Address - Phone:865-922-1400
Practice Address - Fax:865-922-0928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3007919Medicaid
TNA97241Medicare UPIN
TN3007919Medicare ID - Type Unspecified