Provider Demographics
NPI:1861469017
Name:KAELIN, CHARLES ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:KAELIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:ROBERT
Other - Last Name:KAELIN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4998 CROSSINGS CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0018
Mailing Address - Country:US
Mailing Address - Phone:615-553-5000
Mailing Address - Fax:615-758-3875
Practice Address - Street 1:4998 CROSSINGS CIR STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-0018
Practice Address - Country:US
Practice Address - Phone:615-553-5000
Practice Address - Fax:615-758-3875
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25086174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3080389OtherMEDICARE PROVIDER ID
TN3080380Medicaid
B92534Medicare UPIN
TN103I705692Medicare PIN