Provider Demographics
NPI:1013901784
Name:KADOWAKI, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:KADOWAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:121 E RAVINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3816
Practice Address - Country:US
Practice Address - Phone:423-408-7050
Practice Address - Fax:423-408-7054
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN44850208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013901784Medicaid
TN4238238OtherBLUE CROSS TENNESSEE
TN103I022828Medicare PIN
VA1013901784Medicaid
TN4238238OtherBLUE CROSS TENNESSEE
TN103I027726Medicare PIN