Provider Demographics
NPI:1639136179
Name:MIHELIC, FABIAN MATTHEW (MD, FAAFP)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:MATTHEW
Last Name:MIHELIC
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY # U67
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-9352
Mailing Address - Fax:865-305-8681
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:GSM BUILDING 1ST FLOOR
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9350
Practice Address - Fax:865-305-8681
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN34146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3853156Medicaid
TN3373352OtherMEDICARE GROUP
TN3373352OtherMEDICAID GROUP
TN3853156Medicaid
TN103I088013Medicare PIN