Provider Demographics
NPI:1659388197
Name:MARTINOLICH, KEVIN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MATTHEW
Last Name:MARTINOLICH
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 1:1928 ALCOA HWY
Mailing Address - Street 2:MEDICAL BUILDING B, SUITE 119
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1502
Mailing Address - Country:US
Mailing Address - Phone:865-305-8761
Mailing Address - Fax:865-305-9869
Practice Address - Street 1:1928 ALCOA HWY
Practice Address - Street 2:MEDICAL BUILDING B, SUITE 119
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1502
Practice Address - Country:US
Practice Address - Phone:865-305-8761
Practice Address - Fax:865-305-9869
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31837207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3843482Medicaid
TN3843482Medicaid
TN103I297668Medicare PIN