Individual
VIJAY PETHKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
780 NORTH MT JULIET RD, MT JULIET, TN 37122-0780
(615) 758-9273
(615) 758-4821
Mailing address
780 NORTH MT JULIET RD, MT JULIET, TN 37122-0780
(615) 727-1963
(615) 758-4821
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD31687
TN
207RP1001X
Pulmonary Disease Physician
Primary
031687
TN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
031687
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4102896
BLUE CROSS BLUE SHIELD TN
TN
Enumeration date
07/13/2005
Last updated
02/05/2023
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