Provider Demographics
NPI:1861459836
Name:BIELAK, KENNETH MICHAEL (MD, ABFP, MA, MBA)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:BIELAK
Suffix:
Gender:M
Credentials:MD, ABFP, MA, MBA
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:864-305-9350
Mailing Address - Fax:865-305-8681
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:GRADUATE SCHOOL OF MEDICINE 1ST FLOOR
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:864-305-9350
Practice Address - Fax:865-305-8681
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24731208M00000X
TN024731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373352OtherMEDICARE GRP UFP
TN5106119OtherAETNA
TN1689631137OtherGRP NPI
TN3373352OtherMEDICAID GRP UFP
TN100010518OtherPHP TENNCARE
TN3079423Medicaid
TN01-41248OtherUNITED HEALTH CARE
110129782OtherRAILROAD MEDICARE
TN3023732OtherBLUE CROSS/BLUE SHIELD
TN5164017OtherCIGNA
TNTN0155OtherJOHN DEERE
TN3373352OtherMEDICARE GRP UFP
TN3079423Medicaid