Provider Demographics
NPI:1245371400
Name:KLIEFOTH, A. BERNHARD III (MD, FACS, FAHA)
Entity type:Individual
Prefix:
First Name:A.
Middle Name:BERNHARD
Last Name:KLIEFOTH
Suffix:III
Gender:M
Credentials:MD, FACS, FAHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51648
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1648
Mailing Address - Country:US
Mailing Address - Phone:865-524-9400
Mailing Address - Fax:
Practice Address - Street 1:6901 OFFICE PARK CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1162
Practice Address - Country:US
Practice Address - Phone:865-524-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13445207T00000X
CAC33599207T00000X
TXD7126207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery