Provider Demographics
NPI:1982633731
Name:KHAIROLLAHI, VALI (MD)
Entity Type:Individual
Prefix:
First Name:VALI
Middle Name:
Last Name:KHAIROLLAHI
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 1:7035 MIDDLEBROOK PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1156
Mailing Address - Country:US
Mailing Address - Phone:865-544-1550
Mailing Address - Fax:865-544-1570
Practice Address - Street 1:7035 MIDDLEBROOK PIKE STE B
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1156
Practice Address - Country:US
Practice Address - Phone:865-544-1550
Practice Address - Fax:865-544-1570
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6853207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3135631OtherBLUE CROSS BLUE SHILED
TN3138612Medicaid
TN3135631OtherBLUE CROSS BLUE SHILED
TN3138612Medicaid