Basic Information
| Provider Information | |||||||||
| NPI: | 1588645295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISESE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 DODDS AVENUE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238268222 | ||||||||
| FaxNumber: | 4236983622 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 DESALES AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954430 | ||||||||
| FaxNumber: | 4236983622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD0000033819 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | MD0000033819 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085P0229X | MD0000033819 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0204X | MD0000033819 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | MD33819 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.