Provider Demographics
NPI:1033304951
Name:RENTZ, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:RENTZ
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 1:2175 HIGHWAY 75
Mailing Address - Street 2:STE 4
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5861
Mailing Address - Country:US
Mailing Address - Phone:423-323-5290
Mailing Address - Fax:423-323-5653
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-3220
Practice Address - Fax:423-844-3114
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.32930 TL207ZP0102X
TN55024207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC80030488OtherSELECT HEALTH
NC5915766Medicaid
SC9341361OtherAETNA
SCP00911765OtherRAILROAD MEDICARE
SCP00911765OtherRAILROAD MEDICARE