Provider Demographics
NPI:1164488136
Name:SPALDING, MICHAEL JON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:SPALDING
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 1:345 23RD AVE N
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1513
Mailing Address - Country:US
Mailing Address - Phone:615-327-2055
Mailing Address - Fax:615-329-4005
Practice Address - Street 1:345 23RD AVE N
Practice Address - Street 2:SUITE 212
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-327-2055
Practice Address - Fax:615-329-4005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7673208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3858975Medicaid
B02464Medicare UPIN
TN3858975Medicare ID - Type Unspecified