Provider Demographics
NPI:1033173851
Name:YOUNG, MICHAEL E (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10810 PARKSIDE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1980
Mailing Address - Country:US
Mailing Address - Phone:865-647-3350
Mailing Address - Fax:865-647-3359
Practice Address - Street 1:10810 PARKSIDE DR STE 109
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1980
Practice Address - Country:US
Practice Address - Phone:865-647-3350
Practice Address - Fax:865-647-3359
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103770363AM0700X
NC0001-03770363AS0400X
TNPA5616363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1033173851Medicare ID - Type Unspecified
NC2759368Medicare ID - Type Unspecified
NCP97191Medicare UPIN