Provider Demographics
NPI:1952574931
Name:TARECK A. KADRIE, M.D., PLLC
Entity Type:Organization
Organization Name:TARECK A. KADRIE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARECK
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KADRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-698-3423
Mailing Address - Street 1:721 GLENWOOD DR
Mailing Address - Street 2:SUITE 467 WEST
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1106
Mailing Address - Country:US
Mailing Address - Phone:423-698-3423
Mailing Address - Fax:423-698-1380
Practice Address - Street 1:721 GLENWOOD DR
Practice Address - Street 2:SUITE 467 WEST
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1106
Practice Address - Country:US
Practice Address - Phone:423-698-3423
Practice Address - Fax:423-698-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN372122084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726057Medicare PIN
TNH79294Medicare UPIN