Provider Demographics
NPI:1063472157
Name:ZANONE, MICHAEL TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:ZANONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:STE 175
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6403
Mailing Address - Country:US
Mailing Address - Phone:615-988-2014
Mailing Address - Fax:615-523-0647
Practice Address - Street 1:1154 CROSS CREEK DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-5777
Practice Address - Country:US
Practice Address - Phone:615-988-2014
Practice Address - Fax:615-523-0647
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6971208D00000X
ARR3421208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00227112OtherMEDICARE RAILROAD
MS0878990001OtherPALMETTO
TN2002509OtherBLUE CROSS BLUE SHIELD
TN2002509OtherBLUE CROSS BLUE SHIELD
MSP00227112OtherMEDICARE RAILROAD
B03608Medicare UPIN