Provider Demographics
NPI:1346292257
Name:MERTENS, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MERTENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:325 OLD PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4493
Practice Address - Country:US
Practice Address - Phone:629-255-2073
Practice Address - Fax:629-255-4162
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN30767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3839210Medicaid
TN3839216Medicare PIN
TN103I088991Medicare PIN
TNG89310Medicare UPIN
TN4013948OtherTENNCARE
TNP2843111OtherFIRST HEALTH
TN3839216Medicare PIN
TNG89310OtherHEALTHSPRING
TN8597386OtherCIGNA
TN080175212OtherR/R MEDICARE