Individual
DR. THOMAS WANNENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9320 PARK WEST BLVD, KNOXVILLE, TN 37923-4301
(865) 373-7100
(865) 373-7101
Mailing address
9320 PARK WEST BLVD, KNOXVILLE, TN 37923-4301
(865) 373-7100
(865) 373-7101
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
34761
NC
207RC0001X
Clinical Cardiac Electrophysiology Physician
34761
NC
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
52414
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005393000
—
WV
01
—
5692360
AETNA
—
01
—
60067968
RR MEDICARE
—
05
—
6013228
—
VA
01
—
60616
MEDCOST
—
01
—
8490
PARTNERS
—
01
—
85591
BCBS
—
05
—
8985591
—
NC
05
—
Q016063
—
TN
05
—
Q24553
—
SC
Enumeration date
12/13/2005
Last updated
12/13/2021
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