Provider Demographics
NPI:1003981408
Name:OLIVIER, MICHAEL LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEONARD
Last Name:OLIVIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 CUMBERLAND LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-7155
Mailing Address - Country:US
Mailing Address - Phone:605-255-4101
Mailing Address - Fax:605-255-4687
Practice Address - Street 1:3790 CUMBERLAND LAKES DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-7155
Practice Address - Country:US
Practice Address - Phone:931-200-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5809208000000X
TN51982208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74471Medicare UPIN