Provider Demographics
NPI:1063491421
Name:GALLOWAY, MICHAEL STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEWART
Last Name:GALLOWAY
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 1:57 FAIRFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38558-4417
Mailing Address - Country:US
Mailing Address - Phone:931-484-3344
Mailing Address - Fax:931-456-3671
Practice Address - Street 1:57 FAIRFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38558-4417
Practice Address - Country:US
Practice Address - Phone:931-484-3344
Practice Address - Fax:931-456-3671
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024999207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG00811Medicare UPIN
TN3090665Medicare PIN
TN3376762Medicare ID - Type Unspecified
TN3090068Medicare PIN
TN3905700001Medicare NSC